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AMOUNT OF FUNDING PAID TO PIHPs October 10, 2006

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AMOUNT OF FUNDING PAID TO PIHPs October 10, 2006
AMOUNT OF FUNDING PAID TO PIHPs
(FY2007 Appropriation Bill - Public Act 330 of 2006)
October 10, 2006
Section 418: On or before the tenth of each month, the department shall report to
the senate and house of representatives appropriations subcommittee on community
health, the senate and house fiscal agencies, and the state budget director on the
amount of funding paid to the CMHSPs or specialty prepaid health plans to support the
Medicaid managed mental health care program in that month. The information shall
include the total paid to each CMHSP or specialty prepaid health plan, per capita rate
paid for each eligibility group for each CMHSP or specialty prepaid health plan, and
number of cases in each eligibility group for each CMHSP or specialty prepaid health
plan, and year-to-date summary of eligibles and expenditures for the Medicaid
managed mental health care program.
Michigan Medicaid
Mental Health, Substance Abuse and Habilitation Supports Waiver
CAPITATION REPORT
These are the rates calculated under the rate
structure for FY2008.
October, 2007
V2.4
Summary of the Michigan Medicaid capitation data. Including
breakdown of covered lives and revenue by agency providing
services and by county.
For the Mental Health and Substance Abuse programs, only individuals eligible for Medicaid on card cut-off date are
capitated. Therefore, while additional Medicaid eligible individuals are expected for this month, the revenue figures
for payment will not change. Payments for individuals enrolled in the Habilitation Supports Waiver may be paid
retroactively as reflected on the Summary and HSW-Summary pages.
This data does not include any gross adjustments made to the revenue stream. Only revenues paid out through the
capitation system are shown.
Michigan Medicaid Monthly Capitation Summary - Introduction
Section
Page(s)
There are three general types of reports;
Reports with "Capitation" in their titles include both individuals eligible for Medicaid on card cut-off and their revenue data.
Reports with “Population” in their titles include only individuals eligible for Medicaid on card cut-off.
Reports with "Revenue" in their titles include only capitated revenue data.
Generally, if there is a Population report, there is a Revenue report with the same grouping, sorting, and selection criteria.
Generally, each report is first presented at the PIHP level and then at the county level.
SUMMARY - State Level
The first section provides tables and charts of summary totals for the state as a whole.
There are also some Age Profile charts showing the relative shares of the population that is male or female.
SUMMARY - PIHP and County Level
Capitation data summarizing population and revenue by PIHP and county. (Mental Health and Substance Abuse)
Population data by program group and gender for each PIHP and county. (Mental Health and Substance Abuse)
Revenue data by program group and gender for each PIHP and county. (Mental Health and Substance Abuse)
SUMMARY - PIHP and County Level - Habilitation Supports Waiver
Capitation data summarizing population and revenue by PIHP and county. (Habilitation Supports Waiver)
Population data by program group and gender for each PIHP and county. (Habilitation Supports Waiver)
Revenue data by program group and gender for each PIHP. (Habilitation Supports Waiver)
Summary of Payment and Recovery Amounts by PIHP. (Habilitation Supports Waiver)
Summary of Net Enrollees and Net Payments by PIHP. (Habilitation Supports Waiver)
REFERENCE DATA ( Base Rates, Age/Sex Factors, and Geographic Factors)
Notes:
4 - 10
11 - 13
14 - 23
24 - 27
28 - 43
44 - 51
52 - 55
56 - 59
60
61 - 64
65 - 75
While some data is provided at the county level, the actuarial basis for the data is such that revenue numbers are revenues due the PIHP and not the CMH or county. The rates are best
understood as "on average" or "in aggregate" values within any given PIHP. The revenues listed by county are not due that county, nor is that county limited to that revenue from the PIHP.
Revenue distribution within a PIHP is the responsibility of the PIHP.
Approximately the 20th of each month a snapshot of the individuals eligible for Medicaid is taken. This data is the basis for capitation for the following month. It is a prospective determination. Whatever a
person's Medicaid eligibility status is as of that snapshot will be their status for the following month in all published reports, data, and calculations.
If an individual is eligibile for Medicaid on card cut-off, they are capitated for the entire month. No proration of capitation takes place.
Mental Health and Subtance Abuse programs share eligibility determination. Anyone eligible for Medicaid in one program has the same classification and coverage perod in the other program.
Retroactive payments are made only for beneficiaries enrolled in the Habilitation Supports Waiver program. PIHPs are paid at the rate effective in the current month. Habilitation Supports Waiver enrollees
may also have revenue recovery records if a situation arises.
Habilitation Supports Waiver enrollee's capitation is calculated based on the rates applicable to their County of Residence. The capitation is paid to their County of Financial Responsibility.
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Introduction
Page 2 of 79
Michigan Medicaid Monthly Capitation Summary - Table of Contents
Section
Worksheet
Page
Section
INTRODUCTION
General notes on use of the data
2
SUMMARY
Two page summary table of all data
Summary
4
Five page Year to Date Summary
YTD-Summary
Summary Charts
Summary Charts
11
Enrollment Age Profile Charts
Age Profile Charts
12
6
CAPITATION (Summaries with Population and Revenue)
Mental Health Capitation
by PIHP
MH by PIHP
14
MH TANF by PIHP
15
by County
MH by County
16
by PIHP
SA by PIHP
19
TANF by PIHP
SA TANF by PIHP
20
by County
SA by County
21
Substance Abuse Capitation
POPULATION
by PIHP by Program Group and Age Group
MHSA-Pop Common to MH and SA
24
by PIHP
HSW by PIHP
44
by County
HSW by County
45
HSW-Pop
52
HSW-DAB, HSW-TANF
56
POPULATION - Habilitation Supports Waiver
by PIHP by Program Group and Age Group
REVENUE - Habilitation Supports Waiver
Habilitation Supports Waiver
Summary - Habilitation Supports Waiver
Habilitation Supports Waiver
Summary of Payment and Recovery Amounts by PIHP HSW-Summary
60
Net Enrollees and Payments
HSW Net Enrollees & Payments
61
Affiliations
65
Reference Data
Affiliations and Included Counties
Capitation Base Rates
Cap Base Rates
Mental Health Capitaiton Base Rates
68
Substance Abuse Capitation Base Rates
69
Age/Sex Factors
REVENUE
Mental Health Revenue
by PIHP by Gender/Program Group/Age Group
MHSP-DAB, MHSP-TANF State Plan
28
by PIHP by Gender/Program Group/Age Group
MHB3-DAB, MHB3-TANF 1915(b)(3)
32
Substance Abuse Revenue
by PIHP by Gender/Program Group/Age Group
SASP-DAB, SASP-TANF State Plan
36
by PIHP by Gender/Program Group/Age Group
SAB3-DAB, SAB3-TANF 1915(b)(3)
40
Report Generated: 10/15/2007
Page
CAPITATION - Habilitation Supports Waiver (Summaries with Population and Revenue)
Habilitation Supports Waiver
by PIHP by Gender/Program Group/Age Group
TANF by PIHP
Worksheet
12:47 PM
Mental Health Age/Sex Factors
AgeSex Factors MH
70
Substance Abuse Age Sex Factors
AgeSex Factors SA
71
Mental Health Geographic Factors
Geographic Factors MH
72
Substance Abuse Geographic Factors
Geographic Factors SA
74
Geographic Factors
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Table of Contents
Page 3 of 79
Medicaid Capitation Summary
October, 2007
Revenue - Funding Group
1
Group
Mental Health - State Plan Capitation
2
3
Mental Health - 1915(b)(3) Capitation
4
5
Combined MHSP and MHB3 Capitation
6
7
Total Capitation
0 - 17
18 - 25
26 - 39
40 - 49
$
52,425,224.50 $
3,619,012.82
$
5,185,706.48
$
11,466,099.51
$
13,251,383.07
$
14,963,492.24
$
3,939,530.38
TANF
$
8,710,854.06 $
5,735,276.84
$
851,334.76
$
1,399,623.92
$
607,726.29
$
116,891.53
$
0.72
DAB
$
44,498,316.24 $
3,071,727.99
$
4,401,610.51
$
9,732,287.55
$
11,247,651.29
$
12,701,043.46
$
3,343,995.44
TANF
$
1,355,527.52 $
892,336.31
$
132,435.94
$
217,955.88
$
94,587.04
$
18,211.65
$
0.70
DAB
$
96,923,540.74 $
6,690,740.81
$
9,587,316.99
$
21,198,387.06
$
24,499,034.36
$
27,664,535.70
$
7,283,525.82
TANF
$
10,066,381.58 $
6,627,613.15
$
983,770.70
$
1,617,579.80
$
702,313.33
$
135,103.18
$
1.42
$
106,989,922.32 $
13,318,353.96
$
10,571,087.69
$
22,815,966.86
$
25,201,347.69
$
27,799,638.88
$
7,283,527.24
31,166,072.20 $
206,637.42
$
1,510,064.86
$
7,000,232.69
$
8,860,431.66
$
10,502,710.09
$
3,085,995.48
Total MH Capitation (State Plan and 1915(b)(3))
Mental Health - HabSupports Waiver Current Payment
$
8a
Mental Health - HabSupports Waiver - Retro Payments FY 2007-2008
$
8b
Mental Health - HabSupports Waiver - Retro Payments FY 2006-2007
$
132,399.62 $
8c
Mental Health - HabSupports Waiver Total Payments Paid
$
31,298,471.82 $
168,657.00
$
1,378,011.10
$
6,893,124.34
$
138,288,394.14 $
13,487,010.96
$
11,949,098.79
$
DAB
$
1,253,022.90 $
61,549.56
$
131,831.17
TANF
$
831,065.29 $
162,631.72
$
DAB
$
502,811.62 $
24,594.49
TANF
$
373,789.77 $
DAB
$
TANF
10
Combined Mental Health Capitation
Substance Abuse - State Plan Capitation
11
12
Substance Abuse - 1915(b)(3) Capitation
13
14
Combined SASP and SAB3 Capitation
15
$
-
$
$
$
$
-
$
15,150.13
$
9,001,853.64
$
10,755,680.13
$
3,101,145.61
29,709,091.20
$
34,203,201.33
$
38,555,319.01
$
10,384,672.85
$
226,229.47
$
397,471.73
$
417,620.54
$
18,320.43
147,494.77
$
330,187.35
$
156,322.44
$
34,428.31
$
0.70
$
52,850.96
$
90,748.69
$
159,506.80
$
167,642.72
$
7,467.96
73,454.82
$
66,336.33
$
148,276.78
$
70,248.92
$
15,472.22
$
0.70
1,755,834.52 $
86,144.05
$
184,682.13
$
316,978.16
$
556,978.53
$
585,263.26
$
25,788.39
$
1,204,855.06 $
236,086.54
$
213,831.10
$
478,464.13
$
226,571.36
$
49,900.53
$
1.40
2,960,689.58 $
322,230.59
$
398,513.23
$
795,442.29
$
783,549.89
$
635,163.79
$
25,789.79
13,809,241.55
$
12,347,612.02
$
30,504,533.49
$
34,986,751.22
$
39,190,482.80
$
10,410,462.64
Total MA Capitation
$
141,249,083.72
$
(107,108.35) $
-
$
17
(132,053.76) $
-
252,970.04
$
(37,980.42) $
-
$
Total SA Capitation (State Plan and 1915(b)(3))
12:47 PM
-
141,421.98
16
Report Generated: 10/15/2007
65+
DAB
8
9
50 - 64
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Summary
Page 4 of 79
Medicaid Capitation Summary
October, 2007
Population - Funding Group
18
Gender
DAB Population
19
20
21
22
23
Combined Current Medicaid Population*
25
HabSupports Enrollees Current (included above)
26
27
Total HabSupports Enrollees Current (included above)
28
HabSupports Enrollees Retro - Retro Payments FY 2007-2008
29
30
Total HabSupports Enrollees Retro - Retro Payments FY 2007-2008
31
HabSupports Enrollees Retro - Retro Payments FY 2006-2007
32
33
34
Total HabSupports Enrollees Retro - Retro Payments FY 2006-2007
Total HabSupports Enrollees
18 - 25
26 - 39
40 - 49
50 - 64
65+
174,659
40,509
22,777
23,794
26,058
35,720
25,801
Female
222,725
28,363
19,337
24,568
30,111
52,712
67,634
397,384
68,872
42,114
48,362
56,169
88,432
93,435
Male
404,253
355,000
19,907
17,494
8,900
2,913
39
Female
536,878
349,109
70,228
87,825
24,653
5,032
31
941,131
704,109
90,135
105,319
33,553
7,945
70
1,338,515
772,981
132,249
153,681
89,722
96,377
93,505
Male
4,210
56
275
1,014
1,192
1,311
362
Female
3,013
24
139
657
812
1,050
331
7,223
80
414
1,671
2,004
2,361
693
Male
-
-
-
-
-
-
-
Female
-
-
-
-
-
-
-
Total TANF Population
24
0 - 17
Male
Total DAB Population
TANF Population
Total Population
-
-
-
-
-
-
-
Male
13
(1)
(24)
(25)
22
41
-
Female
14
(8)
(10)
2
13
14
3
27
(9)
(34)
(23)
35
55
3
71
380
2,039
2,416
696
7,250
1,648
* SP & B3 Population figures do not include Retroactive Eligibles
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Summary
Page 5 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
October, 2007
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
November
October
1
Provider ID
Billing
Agent
Affiliation DBA
MH(SP)&(b3)
SA(SP)&(b3)
1705322
00GE
Access Alliance of Michigan
$
4,197,095
$
103,689
HSW As of
10/15/2007
$
1,556,707
Subtotal
$
MH(SP)&(b3)
December
HSW As of
10/15/2007
SA(SP)&(b3)
5,857,491
Subtotal
$
MH(SP)&(b3)
HSW As of
10/15/2007
SA(SP)&(b3)
-
Subtotal
$
-
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
5,840,361
$
111,341
$
1,634,479
$
7,586,181
$
-
$
-
3
4344340
00GG
CMH for Central Michigan
$
2,808,728
$
60,939
$
1,827,005
$
4,696,672
$
-
$
-
4
4483587
00GS
CMHSA Network of West Michigan
$
5,985,203
$
157,233
$
580,114
$
6,722,550
$
-
$
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
$ 24,698,925
$
941,186
$
5,516,296
$ 31,156,407
$
-
$
-
6
1705233
0028
Genesee County CMH Services
$
5,786,603
$
252,090
$
1,274,400
$
7,313,094
$
-
$
-
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
3,892,210
$
104,859
$
1,019,535
$
5,016,604
$
-
$
-
8
1712229
00GV
Lifeways
$
2,077,111
$
60,823
$
577,199
$
2,715,133
$
-
$
-
9
3396315
00GX
Macomb County CMH Services
$
8,933,203
$
220,520
$
1,456,449
$ 10,610,172
$
-
$
-
10
1724945
00HJ
Northcare
$
4,540,143
$
69,713
$
1,764,053
$
6,373,909
$
-
$
-
11
4476125
00HF
Northern Affiliation
$
2,367,399
$
74,744
$
2,099,816
$
4,541,960
$
-
$
-
12
4540048
00HC
Northern Lakes
$
2,875,894
$
65,870
$
744,685
$
3,686,449
$
-
$
-
13
1705289
0058
Oakland County CMH Authority
$ 12,534,592
$
198,640
$
3,780,242
$ 16,513,473
$
-
$
-
14
1712541
00HQ
Saginaw County CMH Authority
$
2,423,410
$
98,070
$
543,652
$
3,065,132
$
-
$
-
15
4390138
00HU
Southeast Partnership
$
4,849,920
$
111,463
$
2,515,808
$
7,477,191
$
-
$
-
16
3402136
00GR
Southwest Alliance
$
4,758,425
$
132,803
$
1,607,725
$
6,498,952
$
-
$
-
17
1708164
00HO
Thumb Mental Health Alliance
$
3,935,095
$
71,718
$
1,375,062
$
5,381,875
$
-
$
-
18
2920843
00HR
Venture Behavioral Health
$
4,485,605
$
124,988
$
1,292,847
$
5,903,439
$
-
$
-
State Subtotals $ 106,989,922
$
2,960,690
$
-
$
-
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 10/15/2007
12:47 PM
$ 109,950,612
$ 31,166,072
$ 141,116,684
$
-
$
-
$
-
$
-
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$
-
$
-
$
-
$
-
Page 6 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
October, 2007
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
January
February
HSW As of
10/15/2007
HSW As of
10/15/2007
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
$
-
$
-
$
-
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
-
$
-
$
-
3
4344340
00GG
CMH for Central Michigan
$
-
$
-
$
-
4
4483587
00GS
CMHSA Network of West Michigan
$
-
$
-
$
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
$
-
$
-
$
-
6
1705233
0028
Genesee County CMH Services
$
-
$
-
$
-
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
-
$
-
$
-
8
1712229
00GV
Lifeways
$
-
$
-
$
-
MH(SP)&(b3)
HSW As of
10/15/2007
March
SA(SP)&(b3)
Subtotal
MH(SP)&(b3)
SA(SP)&(b3)
Subtotal
MH(SP)&(b3)
SA(SP)&(b3)
Subtotal
9
3396315
00GX
Macomb County CMH Services
$
-
$
-
$
-
10
1724945
00HJ
Northcare
$
-
$
-
$
-
11
4476125
00HF
Northern Affiliation
$
-
$
-
$
-
12
4540048
00HC
Northern Lakes
$
-
$
-
$
-
13
1705289
0058
Oakland County CMH Authority
$
-
$
-
$
-
14
1712541
00HQ
Saginaw County CMH Authority
$
-
$
-
$
-
15
4390138
00HU
Southeast Partnership
$
-
$
-
$
-
16
3402136
00GR
Southwest Alliance
$
-
$
-
$
-
17
1708164
00HO
Thumb Mental Health Alliance
$
-
$
-
$
-
18
2920843
00HR
Venture Behavioral Health
$
-
$
-
$
-
$
-
$
-
$
-
State Subtotals $
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 10/15/2007
12:47 PM
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$
-
$
-
$
-
$
-
Page 7 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
October, 2007
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
April
June
May
HSW As of
10/15/2007
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
$
-
$
-
$
-
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
-
$
-
$
-
3
4344340
00GG
CMH for Central Michigan
$
-
$
-
$
-
4
4483587
00GS
CMHSA Network of West Michigan
$
-
$
-
$
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
$
-
$
-
$
-
6
1705233
0028
Genesee County CMH Services
$
-
$
-
$
-
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
-
$
-
$
-
8
1712229
00GV
Lifeways
$
-
$
-
$
-
MH(SP)&(b3)
HSW As of
10/15/2007
HSW As of
10/15/2007
Provider ID
SA(SP)&(b3)
Subtotal
MH(SP)&(b3)
SA(SP)&(b3)
Subtotal
MH(SP)&(b3)
SA(SP)&(b3)
Subtotal
9
3396315
00GX
Macomb County CMH Services
$
-
$
-
$
-
10
1724945
00HJ
Northcare
$
-
$
-
$
-
11
4476125
00HF
Northern Affiliation
$
-
$
-
$
-
12
4540048
00HC
Northern Lakes
$
-
$
-
$
-
13
1705289
0058
Oakland County CMH Authority
$
-
$
-
$
-
14
1712541
00HQ
Saginaw County CMH Authority
$
-
$
-
$
-
15
4390138
00HU
Southeast Partnership
$
-
$
-
$
-
16
3402136
00GR
Southwest Alliance
$
-
$
-
$
-
17
1708164
00HO
Thumb Mental Health Alliance
$
-
$
-
$
-
18
2920843
00HR
Venture Behavioral Health
$
-
$
-
$
-
$
-
$
-
$
-
State Subtotals $
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 10/15/2007
12:47 PM
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$
-
$
-
$
-
$
-
Page 8 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
October, 2007
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
July
August
HSW As of
10/15/2007
HSW As of
10/15/2007
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
$
-
$
-
$
-
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
-
$
-
$
-
3
4344340
00GG
CMH for Central Michigan
$
-
$
-
$
-
4
4483587
00GS
CMHSA Network of West Michigan
$
-
$
-
$
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
$
-
$
-
$
-
6
1705233
0028
Genesee County CMH Services
$
-
$
-
$
-
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
-
$
-
$
-
8
1712229
00GV
Lifeways
$
-
$
-
$
-
MH(SP)&(b3)
HSW As of
10/15/2007
September
SA(SP)&(b3)
Subtotal
MH(SP)&(b3)
SA(SP)&(b3)
Subtotal
MH(SP)&(b3)
SA(SP)&(b3)
Subtotal
9
3396315
00GX
Macomb County CMH Services
$
-
$
-
$
-
10
1724945
00HJ
Northcare
$
-
$
-
$
-
11
4476125
00HF
Northern Affiliation
$
-
$
-
$
-
12
4540048
00HC
Northern Lakes
$
-
$
-
$
-
13
1705289
0058
Oakland County CMH Authority
$
-
$
-
$
-
14
1712541
00HQ
Saginaw County CMH Authority
$
-
$
-
$
-
15
4390138
00HU
Southeast Partnership
$
-
$
-
$
-
16
3402136
00GR
Southwest Alliance
$
-
$
-
$
-
17
1708164
00HO
Thumb Mental Health Alliance
$
-
$
-
$
-
18
2920843
00HR
Venture Behavioral Health
$
-
$
-
$
-
$
-
$
-
$
-
State Subtotals $
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 10/15/2007
12:47 PM
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
$
-
$
-
$
-
$
-
Page 9 of 79
Capitation Summaries - Paid To Date By Month by PIHP*
October, 2007
Revenue - Mental Health - State Plan, 1915(b)(3) & HSW
Year to Date
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
$
3
4344340
00GG
CMH for Central Michigan
$
4
4483587
00GS
CMHSA Network of West Michigan
$
5,985,203
5
3119549
00GJ
Detroit Wayne County CMH Agency
$
6
1705233
0028
Genesee County CMH Services
$
7
1712452
00HA
Lakeshore Behavioral Health Alliance
$
8
1712229
00GV
Lifeways
$
MH(SP)&(b3)
$
4,197,095
HSW As of
10/15/2007
SA(SP)&(b3)
$
103,689
5,840,361
$
2,808,728
$
Total
$
1,556,707
$
5,857,491
111,341
$
1,634,479
$
7,586,181
60,939
$
1,827,005
$
4,696,672
$
157,233
$
580,114
$
6,722,550
24,698,925
$
941,186
$
5,516,296
$
31,156,407
5,786,603
$
252,090
$
1,274,400
$
7,313,094
3,892,210
$
104,859
$
1,019,535
$
5,016,604
2,077,111
$
60,823
$
577,199
$
2,715,133
9
3396315
00GX
Macomb County CMH Services
$
8,933,203
$
220,520
$
1,456,449
$
10,610,172
10
1724945
00HJ
Northcare
$
4,540,143
$
69,713
$
1,764,053
$
6,373,909
11
4476125
00HF
Northern Affiliation
$
2,367,399
$
74,744
$
2,099,816
$
4,541,960
12
4540048
00HC
Northern Lakes
$
2,875,894
$
65,870
$
744,685
$
3,686,449
13
1705289
0058
Oakland County CMH Authority
$
12,534,592
$
198,640
$
3,780,242
$
16,513,473
14
1712541
00HQ
Saginaw County CMH Authority
$
2,423,410
$
98,070
$
543,652
$
3,065,132
15
4390138
00HU
Southeast Partnership
$
4,849,920
$
111,463
$
2,515,808
$
7,477,191
16
3402136
00GR
Southwest Alliance
$
4,758,425
$
132,803
$
1,607,725
$
6,498,952
17
1708164
00HO
Thumb Mental Health Alliance
$
3,935,095
$
71,718
$
1,375,062
$
5,381,875
18
2920843
00HR
Venture Behavioral Health
$
4,485,605
$
124,988
$
1,292,847
$
5,903,439
State Subtotals $ 106,989,922
$
2,960,690
$
31,166,072
$
141,116,684
*HSW Payments are reflected by service month. The amounts will
be updated as retro/recovery payments occur for each service
month.
Report Generated: 10/15/2007
12:47 PM
$ 109,950,612
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
YTD-Summary
Page 10 of 79
MA Summary - Charts
October, 2007
Note: The Y axis scales are not the same for these two charts.
Medicaid Population
$16
Thousands
Millions
Medicaid Revenue
800
$14
700
$12
600
$10
500
$8
400
$6
300
MH-State Plan
$4
200
MH-1915(b)(3)
Total DAB
Population
SA-State Plan
$2
SA-1915(b)(3)
Total TANF
Population
100
Total HabSupports
Enrollees
Hab Supports
$-
-
0 - 17
18 - 25
Report Generated: 10/15/2007
26 - 39
12:47 PM
40 - 49
50 - 64
65+
0 - 17
18 - 25
26 - 39
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Summary Charts
40 - 49
50 - 64
65+
Page 11 of 79
MA Age Profile - by Gender - Charts
October, 2007
Note: The Y axis scales are not the same for the three populations.
Age Profile - Mental Health Population
60,000
55,000
50,000
45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
Male Mental Health
Report Generated: 10/15/2007
12:47 PM
Female Mental Health
105
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
-
Mental Health - M and F
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Age Profile Charts
Page 12 of 79
MA Age Profile - by Gender - Charts
October, 2007
Note: The Y axis scales are not the same for the three populations.
Age Profile - Habilitation Supports Waiver Enrollees
Age Profile - DD (E&P)
7,000
250
240
6,500
230
220
6,000
210
200
5,500
190
180
5,000
170
4,500
160
150
4,000
140
130
3,500
120
110
3,000
100
90
2,500
80
2,000
70
60
1,500
50
40
1,000
30
20
500
10
-
Male E&P
Report Generated: 10/15/2007
Female E&P
12:47 PM
E & P - M and F
Male HSW Enrollees
Female HSW Enrollees
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Age Profile Charts
90
80
70
60
50
40
30
20
10
0
90
80
70
60
50
40
30
20
10
0
-
HSW Enrollees - M and F
Page 13 of 79
Mental Health - Capitation by PIHP
October, 2007
Summary by Population by Gender
Paid Population
DAB
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
TANF
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3
4344340
00GG
CMH for Central Michigan
4
4483587
00GS
CMHSA Network of West Michigan
10,300
12,460
24,855
5
3119549
00GJ
Detroit Wayne County CMH Agency
53,187
63,990
113,629
6
1705233
0028
Genesee County CMH Services
9,827
12,079
23,496
7
1712452
00HA
Lakeshore Behavioral Health Alliance
6,048
8,336
8
1712229
00GV
Lifeways
3,795
4,577
00GX
Macomb County CMH Services
9,019
13,133
Affiliation DBA
Male
Female
Male
DAB Capitation
Female
Total
Male
TANF Capitation
Female
Male
Total Capitation
Female
6,357
8,040
15,934
20,075
50,406
$
1,971,417
$
1,629,856
$
281,337
$
314,485
$
4,197,095
10,023
12,903
23,996
30,826
77,748
$
2,697,857
$
2,376,206
$
356,436
$
409,862
$
5,840,361
4,956
6,292
11,244
14,278
36,770
$
1,325,806
$
1,134,052
$
162,529
$
186,341
$
2,808,728
32,121
79,736
$
2,950,792
$
2,572,261
$
215,947
$
246,204
$
5,985,203
160,105
390,911
$
12,447,166
$
10,012,964
$
963,651
$
1,275,143
$
24,698,925
32,959
78,361
$
2,844,815
$
2,497,327
$
193,504
$
250,956
$
5,786,603
16,466
21,012
51,862
$
1,861,983
$
1,770,961
$
122,055
$
137,211
$
3,892,210
8,800
11,443
28,615
$
1,001,709
$
835,336
$
112,088
$
127,978
$
2,077,111
24,330
31,574
78,056
$
4,254,684
$
4,029,612
$
295,518
$
353,389
$
8,933,203
9
3396315
10
1724945
00HJ
Northcare
5,483
7,945
11,674
14,308
39,410
$
2,137,697
$
1,856,739
$
260,834
$
284,874
$
4,540,143
11
4476125
00HF
Northern Affiliation
5,327
7,018
12,798
15,689
40,832
$
1,140,052
$
978,885
$
119,760
$
128,702
$
2,367,399
12
4540048
00HC
Northern Lakes
4,777
6,079
11,722
14,511
37,089
$
1,310,609
$
1,134,848
$
205,799
$
224,638
$
2,875,894
13
1705289
0058
Oakland County CMH Authority
11,712
16,570
24,318
31,742
84,342
$
6,188,152
$
5,517,411
$
379,719
$
449,310
$
12,534,592
14
1712541
00HQ
Saginaw County CMH Authority
5,172
6,219
10,105
14,392
35,888
$
1,238,300
$
1,044,472
$
60,742
$
79,896
$
2,423,410
15
4390138
00HU
Southeast Partnership
7,152
9,577
18,203
23,963
58,895
$
2,309,735
$
2,068,729
$
216,187
$
255,269
$
4,849,920
16
3402136
00GR
Southwest Alliance
7,533
9,576
18,370
23,929
59,408
$
2,284,057
$
2,012,750
$
214,012
$
247,606
$
4,758,425
17
1708164
00HO
Thumb Mental Health Alliance
4,172
5,310
12,011
15,251
36,744
$
1,871,310
$
1,576,796
$
227,221
$
259,767
$
3,935,095
18
2920843
00HR
Venture Behavioral Health
9,819
12,621
22,302
28,700
73,442
$
2,144,377
$
1,893,817
$
209,287
$
238,123
$
4,485,605
19
$
-
20
$
-
State Subtotals
174,659
222,725
397,384
404,253
536,878
941,131
1,338,515
-
$
51,980,519
$
44,943,022
96,923,541
$
4,596,628
$
5,469,754
$
106,989,922
10,066,382
$
106,989,922
-
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH by PIHP
Page 14 of 79
Mental Health - TANF Capitation by PIHP
October, 2007
Summary by Population by Gender
Paid Population - TANF
TANF Non-Healthy Kids
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
TANF - Healthy Kids
TANF Non-Healthy Kids Capitation
TANF Healthy Kids Capitation
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
15,691
19,843
243
232
36,009
$
277,038
$
311,271
$
4,299
$
3,214
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
23,744
30,566
252
260
54,822
$
352,663
$
406,883
$
3,773
$
2,979
3
4344340
00GG
CMH for Central Michigan
11,092
14,152
152
126
25,522
$
160,342
$
184,913
$
2,188
$
1,428
4
4483587
00GS
CMHSA Network of West Michigan
24,602
31,900
253
221
56,976
$
213,731
$
244,740
$
2,217
$
1,464
5
3119549
00GJ
Detroit Wayne County CMH Agency
112,985
159,377
644
728
273,734
$
958,131
$
1,270,272
$
5,521
$
4,871
6
1705233
0028
Genesee County CMH Services
23,299
32,773
197
186
56,455
$
191,878
$
249,762
$
1,626
$
1,195
7
1712452
00HA
Lakeshore Behavioral Health Alliance
16,278
20,811
188
201
37,478
$
120,647
$
136,050
$
1,409
$
1,161
8
1712229
00GV
Lifeways
8,706
11,345
94
98
20,243
$
110,875
$
126,994
$
1,213
$
984
9
3396315
00GX
Macomb County CMH Services
24,060
31,308
270
266
55,904
$
292,215
$
350,845
$
3,303
$
2,544
10
1724945
00HJ
Northcare
11,456
14,095
218
213
25,982
$
255,957
$
281,114
$
4,877
$
3,760
11
4476125
00HF
Northern Affiliation
12,560
15,451
238
238
28,487
$
117,536
$
126,983
$
2,224
$
1,719
12
4540048
00HC
Northern Lakes
11,526
14,336
196
175
26,233
$
202,341
$
222,277
$
3,459
$
2,361
13
1705289
0058
Oakland County CMH Authority
24,009
31,431
309
311
56,060
$
374,833
$
445,475
$
4,886
$
3,835
14
1712541
00HQ
Saginaw County CMH Authority
10,030
14,299
75
93
24,497
$
60,290
$
79,469
$
452
$
427
15
4390138
00HU
Southeast Partnership
18,011
23,774
192
189
42,166
$
213,876
$
253,533
$
2,311
$
1,736
16
3402136
00GR
Southwest Alliance
18,174
23,735
196
194
42,299
$
211,706
$
245,853
$
2,306
$
1,754
17
1708164
00HO
Thumb Mental Health Alliance
11,848
15,074
163
177
27,262
$
224,134
$
257,135
$
3,087
$
2,633
18
2920843
00HR
Venture Behavioral Health
22,013
28,470
289
230
51,002
$
206,560
$
236,444
$
2,727
$
1,679
400,084
532,740
4,169
4,138
941,131
$
4,544,750
$
5,430,011
$
51,878
$
39,743
Male
Female
Male
Female
Total
Male
Female
Male
Female
19
20
State Subtotals
932,824
Report Generated: 10/15/2007
12:47 PM
8,307
-
9,974,761
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH TANF by PIHP
91,621
Page 15 of 79
Total TANF
Capitation
$
595,822
$
766,298
$
348,871
$
462,151
$
2,238,794
$
444,460
$
259,266
$
240,066
$
648,907
$
545,708
$
248,463
$
430,437
$
829,029
$
140,638
$
471,455
$
461,618
$
486,989
$
447,410
$
-
$
-
$
10,066,382
$
10,066,382
-
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH TANF by PIHP
Page 16 of 79
Mental Health - Capitation by County
October, 2007
Summary by Population by Gender
Paid Population
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
DAB
Provider ID
Billing
Agent
Code
1
4476125
00HF
01
ALCONA
2
1724945
00HJ
02
ALGER
3
3402136
00GR
03
ALLEGAN
4
4476125
00HF
04
ALPENA
5
4476125
00HF
05
ANTRIM
6
1705322
00GE
06
ARENAC
7
1724945
00HJ
07
BARAGA
133
8
2920843
00HR
08
BARRY
9
1705322
00GE
09
BAY
10
1708001
00BJ
10
BENZIE
11
2920843
00HR
11
12
2920843
00HR
12
13
2920843
00HR
13
CALHOUN
14
3402136
00GR
14
15
4476125
00HF
15
16
4476125
00HF
17
1724945
18
4344340
19
1708001
20
21
County Name
Male
197
TANF
Female
287
Male
373
DAB Capitation
Female
494
Total
Male
1,351
$
TANF Capitation
Female
42,251
$
Male
36,710
$
Total Capitation
Female
3,538
$
4,191
$
86,691
145
259
339
379
1,122
$
49,936
$
55,787
$
7,628
$
7,645
$
120,996
1,404
1,847
4,370
5,321
12,942
$
412,633
$
363,656
$
50,962
$
53,621
$
880,871
749
977
1,355
1,758
4,839
$
173,340
$
150,283
$
12,722
$
14,836
$
351,181
412
460
1,072
1,285
3,229
$
84,729
$
61,216
$
9,947
$
9,973
$
165,865
419
518
851
978
2,766
$
129,447
$
106,859
$
15,047
$
15,310
$
266,663
268
375
454
1,230
$
50,787
$
59,155
$
8,448
$
9,112
$
127,502
662
918
2,144
2,562
6,286
$
141,623
$
132,565
$
20,163
$
21,123
$
315,474
2,044
2,721
4,662
6,271
15,698
$
657,773
$
565,993
$
82,368
$
99,633
$
1,405,767
269
356
733
780
2,138
$
72,320
$
62,117
$
10,796
$
10,021
$
155,254
BERRIEN
3,581
4,737
7,196
9,779
25,293
$
765,074
$
699,060
$
67,178
$
81,478
$
1,612,791
BRANCH
786
983
2,069
2,463
6,301
$
169,161
$
141,010
$
19,484
$
20,153
$
349,808
3,183
3,964
6,761
8,900
22,808
$
717,534
$
625,804
$
63,563
$
74,355
$
1,481,256
CASS
981
1,149
2,249
2,942
7,321
$
288,591
$
225,033
$
26,259
$
31,135
$
571,018
CHARLEVOIX
295
434
939
1,153
2,821
$
58,270
$
56,083
$
8,707
$
8,943
$
132,003
16
CHEBOYGAN
513
709
1,426
1,659
4,307
$
105,508
$
98,993
$
13,329
$
13,363
$
231,193
00HJ
17
CHIPPEWA
690
846
1,509
1,795
4,840
$
267,546
$
221,653
$
33,652
$
35,201
$
558,052
00GG
18
CLARE
860
1,073
1,911
2,325
6,169
$
239,637
$
208,400
$
27,831
$
30,543
$
506,410
00BJ
19
CLINTON
590
733
1,480
1,891
4,694
$
156,049
$
133,204
$
21,893
$
24,622
$
335,768
4540048
00HC
20
CRAWFORD
285
375
708
851
2,219
$
79,341
$
70,422
$
12,476
$
13,371
$
175,610
1724945
00HJ
21
DELTA
725
1,018
1,543
1,911
5,197
$
287,936
$
249,970
$
34,362
$
37,973
$
610,241
22
1724945
00HJ
22
DICKINSON
441
704
977
1,327
3,449
$
167,466
$
157,578
$
21,803
$
26,686
$
373,534
23
1708001
00BJ
23
EATON
1,154
1,525
3,182
4,325
10,186
$
302,256
$
266,026
$
47,262
$
57,468
$
673,012
24
4476125
00HF
24
EMMET
462
697
1,432
1,609
4,200
$
90,155
$
86,942
$
13,278
$
12,661
$
203,036
25
1705233
0028
25
GENESEE
9,827
12,079
23,496
32,959
78,361
$
2,844,815
$
2,497,327
$
193,504
$
250,956
$
5,786,603
26
4344340
00GG
26
GLADWIN
570
763
1,232
1,487
4,052
$
155,712
$
137,201
$
17,808
$
19,338
$
330,059
27
1724945
00HJ
27
GOGEBIC
357
573
709
879
2,518
$
139,660
$
131,337
$
15,890
$
17,988
$
304,874
28
4540048
00HC
28
GRAND TRAVERSE
1,162
1,559
2,935
3,776
9,432
$
307,093
$
285,634
$
51,274
$
57,492
$
701,493
29
1708001
00BJ
29
GRATIOT
765
1,093
1,941
2,396
6,195
$
199,474
$
184,170
$
28,907
$
31,751
$
444,301
30
1712229
00GV
30
HILLSDALE
869
1,084
2,041
2,554
6,548
$
230,388
$
185,007
$
26,031
$
28,204
$
469,630
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH by County
Page 17 of 79
Mental Health - Capitation by County
October, 2007
Summary by Population by Gender
Paid Population
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
DAB
TANF
DAB Capitation
TANF Capitation
Total Capitation
Provider ID
Billing
Agent
Code
County Name
31
1724945
00HJ
31
HOUGHTON
606
864
1,462
1,697
4,629
$
246,514
$
185,133
$
32,484
$
32,509
$
496,639
32
1705322
00GE
32
HURON
644
845
1,484
1,811
4,784
$
198,775
$
155,589
$
26,216
$
28,030
$
408,611
33
1708001
00BJ
33
INGHAM
4,814
6,032
10,723
14,152
35,721
$
1,304,849
$
1,138,979
$
159,352
$
190,924
$
2,794,104
34
1708001
00BJ
34
IONIA
899
1,185
2,484
3,129
7,697
$
244,014
$
225,751
$
36,807
$
40,709
$
547,281
35
4476125
00HF
35
IOSCO
571
778
1,311
1,572
4,232
$
127,741
$
111,409
$
12,330
$
13,326
$
264,806
36
1724945
00HJ
36
IRON
285
443
502
623
1,853
$
114,133
$
77,839
$
11,245
$
12,585
$
215,803
37
4344340
00GG
37
ISABELLA
948
1,186
2,161
2,909
7,204
$
254,689
$
214,744
$
31,123
$
37,986
$
538,542
38
1712229
00GV
38
JACKSON
2,926
3,493
6,759
8,889
22,067
$
771,321
$
650,329
$
86,057
$
99,774
$
1,607,481
39
3402136
00GR
39
KALAMAZOO
4,044
5,116
8,691
11,777
29,628
$
1,259,430
$
1,128,584
$
101,186
$
123,581
$
2,612,781
40
4476125
00HF
40
KALKASKA
362
473
972
1,243
3,050
$
66,501
$
65,225
$
9,088
$
10,143
$
150,956
41
4483587
00GS
41
KENT
10,300
12,460
24,855
32,121
79,736
$
2,950,792
$
2,572,261
$
215,947
$
246,204
$
5,985,203
42
1724945
00HJ
42
KEWEENAW
44
56
58
65
223
$
17,861
$
10,915
$
1,285
$
1,242
$
31,302
43
4540048
00HC
43
LAKE
429
547
590
720
2,286
$
115,380
$
103,503
$
10,482
$
11,368
$
240,732
44
1708164
00HO
44
LAPEER
879
1,175
3,085
3,703
8,842
$
394,019
$
342,152
$
57,981
$
61,421
$
855,573
45
4540048
00HC
45
LEELANAU
46
4390138
00HU
46
LENAWEE
47
4390138
00HU
47
LIVINGSTON
48
1724945
00HJ
48
LUCE
200
238
286
49
1724945
00HJ
49
MACKINAC
173
222
379
50
3396315
00GX
50
MACOMB
9,019
13,133
24,330
31,574
51
1708001
00BJ
51
MANISTEE
492
654
1,038
52
1724945
00HJ
52
MARQUETTE
936
1,369
2,009
53
4540048
00HC
53
MASON
544
701
1,361
1,743
54
4344340
00GG
54
MECOSTA
781
1,068
1,953
55
1724945
00HJ
55
MENOMINEE
383
565
831
56
4344340
00GG
56
MIDLAND
1,280
1,614
2,894
3,709
57
4540048
00HC
57
MISSAUKEE
235
279
640
58
4390138
00HU
58
MONROE
1,656
2,382
4,304
59
1705322
00GE
59
MONTCALM
1,199
1,378
3,157
60
4476125
00HF
60
MONTMORENCY
248
306
467
Report Generated: 10/15/2007
12:47 PM
Male
Female
Male
Female
Total
Male
Female
Male
Female
126
168
405
481
1,180
$
30,614
$
27,574
$
7,095
$
7,377
$
72,660
1,341
1,862
3,625
4,589
11,417
$
431,732
$
406,301
$
43,061
$
47,840
$
928,934
912
1,188
2,925
3,644
8,669
$
281,227
$
250,249
$
34,713
$
38,348
$
604,537
355
1,079
$
73,923
$
57,009
$
6,377
$
6,964
$
144,273
426
1,200
$
62,255
$
56,177
$
8,458
$
8,289
$
135,179
78,056
$
4,254,684
$
4,029,612
$
295,518
$
353,389
$
8,933,203
1,263
3,447
$
133,338
$
123,112
$
15,456
$
16,557
$
288,463
2,471
6,785
$
380,271
$
345,252
$
44,929
$
50,616
$
821,068
4,349
$
148,374
$
130,681
$
23,843
$
26,915
$
329,813
2,471
6,273
$
200,660
$
197,811
$
28,290
$
32,453
$
459,213
1,081
2,860
$
133,400
$
127,823
$
18,615
$
21,521
$
301,358
9,497
$
342,451
$
270,527
$
41,707
$
48,140
$
702,825
789
1,943
$
59,560
$
47,753
$
11,246
$
12,197
$
130,757
5,797
14,139
$
550,478
$
519,243
$
51,213
$
61,627
$
1,182,560
3,852
9,586
$
364,802
$
288,619
$
55,729
$
59,302
$
768,453
588
1,609
$
54,738
$
43,913
$
4,409
$
5,008
$
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH by County
108,068
Page 18 of 79
Mental Health - Capitation by County
October, 2007
Summary by Population by Gender
Paid Population
Revenue - Mental Health Capitation - State Plan and 1915(b)(3)
DAB
TANF
DAB Capitation
TANF Capitation
Total Capitation
Provider ID
Billing
Agent
Code
County Name
61
1712452
00HA
61
MUSKEGON
4,189
5,679
9,742
13,161
32,771
$
1,313,605
$
1,240,250
$
72,515
$
87,974
$
2,714,343
62
1708001
00BJ
62
NEWAYGO
1,040
1,325
2,415
2,890
7,670
$
285,557
$
242,848
$
35,964
$
37,810
$
602,179
63
1705289
0058
63
OAKLAND
11,712
16,570
24,318
31,742
84,342
$
6,188,152
$
5,517,411
$
379,719
$
449,310
$
12,534,592
64
4540048
00HC
64
OCEANA
555
694
1,948
2,163
5,360
$
157,807
$
125,434
$
34,248
$
32,662
$
350,151
65
4476125
00HF
65
OGEMAW
607
723
1,295
1,581
4,206
$
140,957
$
109,206
$
12,247
$
13,532
$
275,941
66
1724945
00HJ
66
ONTONAGON
161
243
270
339
1,013
$
60,513
$
54,229
$
6,119
$
6,615
$
127,476
67
4344340
00GG
67
OSCEOLA
517
588
1,093
1,377
3,575
$
132,657
$
105,369
$
15,770
$
17,882
$
271,679
68
4476125
00HF
68
OSCODA
249
315
449
523
1,536
$
56,258
$
44,308
$
4,235
$
4,338
$
109,139
69
4476125
00HF
69
OTSEGO
411
520
1,226
1,633
3,790
$
87,857
$
71,859
$
11,474
$
13,777
$
184,968
70
1712452
00HA
70
OTTAWA
1,859
2,657
6,724
7,851
19,091
$
548,379
$
530,711
$
49,541
$
49,237
$
1,177,867
71
4476125
00HF
71
PRESQUE ISLE
251
339
481
591
1,662
$
51,748
$
42,737
$
4,455
$
4,611
$
103,551
72
4540048
00HC
72
ROSCOMMON
671
833
1,283
1,569
4,356
$
199,483
$
163,815
$
22,677
$
25,599
$
411,574
73
1712541
00HQ
73
SAGINAW
5,172
6,219
10,105
14,392
35,888
$
1,238,300
$
1,044,472
$
60,742
$
79,896
$
2,423,410
74
1708164
00HO
74
ST CLAIR
2,497
3,129
6,735
8,703
21,064
$
1,118,836
$
959,332
$
127,680
$
150,506
$
2,356,354
75
3402136
00GR
75
ST JOSEPH
1,104
1,464
3,060
3,889
9,517
$
323,402
$
295,476
$
35,606
$
39,270
$
693,754
76
1708164
00HO
76
SANILAC
796
1,006
2,191
2,845
6,838
$
358,456
$
275,312
$
41,560
$
47,840
$
723,168
77
1724945
00HJ
77
SCHOOLCRAFT
204
277
425
506
1,412
$
85,497
$
66,882
$
9,539
$
9,927
$
171,845
78
1705322
00GE
78
SHIAWASSEE
1,053
1,397
3,174
3,932
9,556
$
321,767
$
280,059
$
56,065
$
62,307
$
720,198
79
1705322
00GE
79
TUSCOLA
998
1,181
2,606
3,231
8,016
$
298,853
$
232,736
$
45,912
$
49,902
$
627,404
80
2920843
00HR
80
VAN BUREN
1,607
2,019
4,132
4,996
12,754
$
350,985
$
295,378
$
38,899
$
41,014
$
726,276
81
4390138
00HU
81
WASHTENAW
82
3119549
00GJ
82
WAYNE
83
4540048
00HC
83
WEXFORD
Male
State Subtotals
Female
Male
Female
Total
Male
Female
Male
Female
3,243
4,145
7,349
9,933
24,670
$
1,046,298
$
892,937
$
87,200
$
107,454
$
2,133,889
53,187
63,990
113,629
160,105
390,911
$
12,447,166
$
10,012,964
$
963,651
$
1,275,143
$
24,698,925
770
923
1,852
2,419
5,964
$
212,956
$
180,033
$
32,459
$
37,656
$
463,104
174,659
222,725
404,253
536,878
1,338,515
$
51,980,519
$
44,943,022
$
4,596,628
$
5,469,754
$106,989,922
106,989,922
$106,989,922
397,384
941,131
-
-
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MH by County
Page 19 of 79
Substance Abuse - Capitation by PIHP
October, 2007
Summary by Population by Gender
Paid Population
DAB
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3
4344340
00GG
CMH for Central Michigan
4
4483587
00GS
5
3119549
6
1705233
7
8
9
Male
Revenue - Substance Abuse - State Plan and 1915(b)(3)
TANF
Female
Male
DAB Capitation
Female
Total
Male
TANF Capitation
Female
Male
Total Capitation
Female
6,357
8,040
15,934
20,075
50,406
$
24,183
$
19,227
$
21,478
$
38,802
$
103,689
10,023
12,903
23,996
30,826
77,748
$
29,206
$
25,090
$
18,680
$
38,365
$
111,341
4,956
6,292
11,244
14,278
36,770
$
18,338
$
15,194
$
9,809
$
17,598
$
60,939
CMHSA Network of West Michigan
10,300
12,460
24,855
32,121
79,736
$
51,859
$
45,035
$
18,972
$
41,367
$
157,233
00GJ
Detroit Wayne County CMH Agency
53,187
63,990
113,629
160,105
390,911
$
397,720
$
301,958
$
63,680
$
177,829
$
941,186
0028
Genesee County CMH Services
9,827
12,079
23,496
32,959
78,361
$
67,921
$
59,323
$
36,499
$
88,347
$
252,090
1712452
00HA
Lakeshore Behavioral Health Alliance
6,048
8,336
16,466
21,012
51,862
$
27,827
$
26,071
$
16,578
$
34,383
$
104,859
1712229
00GV
Lifeways
3,795
4,577
8,800
11,443
28,615
$
14,280
$
11,673
$
11,569
$
23,302
$
60,823
3396315
00GX
Macomb County CMH Services
9,019
13,133
24,330
31,574
78,056
$
65,563
$
58,356
$
30,929
$
65,671
$
220,520
10
1724945
00HJ
Northcare
5,483
7,945
11,674
14,308
39,410
$
19,570
$
15,575
$
12,038
$
22,529
$
69,713
11
4476125
00HF
Northern Affiliation
5,327
7,018
12,798
15,689
40,832
$
21,567
$
17,279
$
13,279
$
22,619
$
74,744
12
4540048
00HC
Northern Lakes
4,777
6,079
11,722
14,511
37,089
$
18,095
$
14,890
$
11,811
$
21,075
$
65,870
13
1705289
0058
Oakland County CMH Authority
11,712
16,570
24,318
31,742
84,342
$
63,658
$
53,311
$
24,868
$
56,803
$
198,640
14
1712541
00HQ
Saginaw County CMH Authority
5,172
6,219
10,105
14,392
35,888
$
32,230
$
26,791
$
10,963
$
28,086
$
98,070
15
4390138
00HU
Southeast Partnership
7,152
9,577
18,203
23,963
58,895
$
27,573
$
24,150
$
18,752
$
40,988
$
111,463
16
3402136
00GR
Southwest Alliance
7,533
9,576
18,370
23,929
59,408
$
39,575
$
33,891
$
19,192
$
40,145
$
132,803
17
1708164
00HO
Thumb Mental Health Alliance
4,172
5,310
12,011
15,251
36,744
$
15,041
$
12,162
$
15,056
$
29,459
$
71,718
18
2920843
00HR
Venture Behavioral Health
9,819
12,621
22,302
28,700
73,442
$
33,299
$
28,354
$
21,163
$
42,171
$
124,988
19
$
-
20
$
-
State Subtotals
174,659
222,725
397,384
404,253
536,878
941,131
1,338,515
-
$
967,505
$
788,329
1,755,835
$
375,316
$
829,539
$
2,960,690
1,204,855
$
2,960,690
-
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA by PIHP
Page 20 of 79
Substance Abuse - TANF Capitation by PIHP
October, 2007
Summary by Population by Gender
Paid Population - TANF
TANF Non-Healthy Kids
Revenue - Substance Abuse - State Plan and 1915(b)(3)
TANF - Healthy Kids
TANF Non-Healthy Kids Capitation
TANF Healthy Kids Capitation
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
15,691
19,843
243
232
36,009
$
21,057
$
38,475
$
420
$
326
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
23,744
30,566
252
260
54,822
$
18,394
$
38,160
$
286
$
205
3
4344340
00GG
CMH for Central Michigan
11,092
14,152
152
126
25,522
$
9,664
$
17,491
$
145
$
107
4
4483587
00GS
CMHSA Network of West Michigan
24,602
31,900
253
221
56,976
$
18,684
$
41,196
$
288
$
171
5
3119549
00GJ
Detroit Wayne County CMH Agency
112,985
159,377
644
728
273,734
$
63,125
$
177,329
$
555
$
500
6
1705233
0028
Genesee County CMH Services
23,299
32,773
197
186
56,455
$
36,106
$
88,043
$
393
$
304
7
1712452
00HA
Lakeshore Behavioral Health Alliance
16,278
20,811
188
201
37,478
$
16,282
$
34,154
$
296
$
229
8
1712229
00GV
Lifeways
8,706
11,345
94
98
20,243
$
11,365
$
23,149
$
204
$
152
00GX
Macomb County CMH Services
24,060
31,308
270
266
55,904
$
30,457
$
65,306
$
472
$
365
Affiliation DBA
Male
Female
Male
Female
Total
Male
Female
Male
Female
9
3396315
10
1724945
00HJ
Northcare
11,456
14,095
218
213
25,982
$
11,760
$
22,281
$
278
$
248
11
4476125
00HF
Northern Affiliation
12,560
15,451
238
238
28,487
$
12,991
$
22,382
$
288
$
237
12
4540048
00HC
Northern Lakes
11,526
14,336
196
175
26,233
$
11,544
$
20,910
$
267
$
166
13
1705289
0058
Oakland County CMH Authority
24,009
31,431
309
311
56,060
$
24,361
$
56,415
$
507
$
388
14
1712541
00HQ
Saginaw County CMH Authority
10,030
14,299
75
93
24,497
$
10,861
$
27,988
$
103
$
98
15
4390138
00HU
Southeast Partnership
18,011
23,774
192
189
42,166
$
18,427
$
40,784
$
325
$
204
16
3402136
00GR
Southwest Alliance
18,174
23,735
196
194
42,299
$
18,878
$
39,928
$
314
$
217
17
1708164
00HO
Thumb Mental Health Alliance
11,848
15,074
163
177
27,262
$
14,804
$
29,220
$
252
$
240
18
2920843
00HR
Venture Behavioral Health
22,013
28,470
289
230
51,002
$
20,787
$
41,938
$
376
$
234
400,084
532,740
4,169
4,138
941,131
$
369,546
$
825,148
$
5,769
$
19
20
State Subtotals
932,824
Report Generated: 10/15/2007
12:47 PM
8,307
-
1,194,694
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA TANF by PIHP
4,391
10,161
Page 21 of 79
Total TANF
Capitation
$
60,280
$
57,045
$
27,407
$
60,339
$
241,508
$
124,846
$
50,961
$
34,871
$
96,601
$
34,567
$
35,899
$
32,886
$
81,671
$
39,049
$
59,740
$
59,337
$
44,515
$
63,335
$
-
$
-
$
1,204,855
$
1,204,855
-
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA TANF by PIHP
Page 22 of 79
Substance Abuse - Capitation by County
October, 2007
Summary by Population Group and Gender
Revenue - Substance Abuse - State Plan and 1915(b)(3)
Paid Population
TANF
DAB
DAB Capitation
TANF Capitation
Total Capitation
Provider ID
Billing
Agent
Code
1
4476125
00HF
01
ALCONA
197
287
373
494
1,351
$
822
$
615
$
472
$
778
$
2,687
2
1724945
00HJ
02
ALGER
145
259
339
379
1,122
$
445
$
434
$
392
$
613
$
1,884
3
3402136
00GR
03
ALLEGAN
1,404
1,847
4,370
5,321
12,942
$
7,067
$
5,962
$
4,630
$
8,093
$
25,752
4
4476125
00HF
04
ALPENA
749
977
1,355
1,758
4,839
$
3,290
$
2,767
$
1,542
$
2,787
$
10,387
5
4476125
00HF
05
ANTRIM
412
460
1,072
1,285
3,229
$
1,585
$
1,062
$
895
$
1,502
$
5,045
6
1705322
00GE
06
ARENAC
419
518
851
978
2,766
$
1,636
$
1,272
$
1,215
$
1,868
$
5,991
7
1724945
00HJ
07
BARAGA
133
268
375
454
1,230
$
476
$
474
$
441
$
743
$
2,134
8
2920843
00HR
08
BARRY
662
918
2,144
2,562
6,286
$
2,176
$
1,975
$
2,117
$
3,675
$
9,942
2,044
2,721
4,662
6,271
15,698
$
8,077
$
6,728
$
6,380
$
12,800
$
33,985
269
356
733
780
2,138
$
800
$
635
$
496
$
851
$
2,782
3,581
4,737
7,196
9,779
25,293
$
11,883
$
10,418
$
6,052
$
14,600
$
42,952
County Name
Male
Female
Male
Female
9
1705322
00GE
09
BAY
10
1708001
00BJ
10
BENZIE
11
2920843
00HR
11
BERRIEN
12
2920843
00HR
12
BRANCH
13
2920843
00HR
13
CALHOUN
14
3402136
00GR
14
15
4476125
00HF
16
4476125
00HF
17
1724945
00HJ
18
4344340
00GG
18
19
1708001
00BJ
19
20
4540048
00HC
20
CRAWFORD
21
1724945
00HJ
21
22
1724945
00HJ
22
23
1708001
00BJ
23
EATON
24
4476125
00HF
24
EMMET
462
697
1,432
25
1705233
0028
25
GENESEE
9,827
12,079
23,496
26
4344340
00GG
26
GLADWIN
570
763
1,232
1,487
27
1724945
00HJ
27
GOGEBIC
28
4540048
00HC
28
GRAND TRAVERSE
29
1708001
00BJ
29
GRATIOT
Total
Male
Female
Male
Female
786
983
2,069
2,463
6,301
$
2,589
$
2,086
$
2,170
$
3,470
$
10,315
3,183
3,964
6,761
8,900
22,808
$
11,189
$
9,502
$
6,632
$
13,419
$
40,741
CASS
981
1,149
2,249
2,942
7,321
$
4,969
$
3,698
$
2,518
$
5,325
$
16,511
15
CHARLEVOIX
295
434
939
1,153
2,821
$
1,107
$
955
$
752
$
1,342
$
4,157
16
CHEBOYGAN
513
709
1,426
1,659
4,307
$
1,977
$
1,724
$
1,444
$
2,248
$
7,393
17
CHIPPEWA
690
846
1,509
1,795
4,840
$
2,516
$
1,972
$
1,495
$
2,695
$
8,678
CLARE
860
1,073
1,911
2,325
6,169
$
3,425
$
2,846
$
1,880
$
2,906
$
11,057
CLINTON
590
733
1,480
1,891
4,694
$
1,665
$
1,406
$
1,033
$
2,183
$
6,287
285
375
708
851
2,219
$
1,112
$
927
$
787
$
1,285
$
4,111
DELTA
725
1,018
1,543
1,911
5,197
$
2,591
$
2,141
$
1,471
$
2,989
$
9,191
DICKINSON
441
704
977
1,327
3,449
$
1,487
$
1,315
$
974
$
2,155
$
5,931
1,154
1,525
3,182
4,325
10,186
$
3,215
$
2,759
$
2,425
$
5,376
$
13,775
1,609
4,200
$
1,633
$
1,453
$
1,203
$
1,978
$
6,266
32,959
78,361
$
67,921
$
59,323
$
36,499
$
88,347
$
252,090
4,052
$
2,206
$
1,806
$
1,093
$
1,789
$
6,893
Report Generated: 10/15/2007
12:47 PM
357
573
709
879
2,518
$
1,271
$
1,108
$
762
$
1,517
$
4,658
1,162
1,559
2,935
3,776
9,432
$
4,189
$
3,718
$
2,577
$
5,168
$
15,652
765
1,093
1,941
2,396
6,195
$
2,093
$
1,858
$
1,584
$
2,961
$
8,497
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA by County
Page 23 of 79
Substance Abuse - Capitation by County
October, 2007
Summary by Population Group and Gender
Revenue - Substance Abuse - State Plan and 1915(b)(3)
Paid Population
TANF
DAB
DAB Capitation
TANF Capitation
Total Capitation
Provider ID
Billing
Agent
30
1712229
00GV
30
HILLSDALE
869
1,084
2,041
2,554
6,548
$
3,309
$
2,493
$
2,822
$
4,967
$
13,590
31
1724945
00HJ
31
HOUGHTON
606
864
1,462
1,697
4,629
$
2,290
$
1,484
$
1,350
$
2,327
$
7,451
32
1705322
00GE
32
HURON
644
845
1,484
1,811
4,784
$
2,485
$
1,756
$
2,023
$
3,325
$
9,589
33
1708001
00BJ
33
INGHAM
4,814
6,032
10,723
14,152
35,721
$
14,228
$
12,186
$
8,445
$
18,440
$
53,299
34
1708001
00BJ
34
IONIA
899
1,185
2,484
3,129
7,697
$
2,611
$
2,391
$
1,849
$
3,642
$
10,493
35
4476125
00HF
35
IOSCO
571
778
1,311
1,572
4,232
$
2,444
$
1,987
$
1,478
$
2,509
$
8,418
36
1724945
00HJ
36
IRON
285
443
502
623
1,853
$
1,086
$
541
$
543
$
1,024
$
3,194
37
4344340
00GG
37
ISABELLA
948
1,186
2,161
2,909
7,204
$
3,407
$
2,888
$
1,740
$
3,617
$
11,651
38
1712229
00GV
38
JACKSON
2,926
3,493
6,759
8,889
22,067
$
10,971
$
9,180
$
8,748
$
18,335
$
47,233
39
3402136
00GR
39
KALAMAZOO
4,044
5,116
8,691
11,777
29,628
$
22,020
$
19,354
$
8,927
$
20,714
$
71,015
40
4476125
00HF
40
KALKASKA
362
473
972
1,243
3,050
$
1,240
$
1,135
$
1,019
$
1,766
$
5,160
41
4483587
00GS
41
KENT
10,300
12,460
24,855
32,121
79,736
$
51,859
$
45,035
$
18,972
$
41,367
$
157,233
42
1724945
00HJ
42
KEWEENAW
44
56
58
65
223
$
164
$
80
$
46
$
89
$
378
43
4540048
00HC
43
LAKE
429
547
590
720
2,286
$
1,658
$
1,363
$
732
$
1,115
$
4,869
44
1708164
00HO
44
LAPEER
879
1,175
3,085
3,703
8,842
$
3,104
$
2,610
$
3,305
$
6,521
$
15,539
45
4540048
00HC
45
LEELANAU
46
4390138
00HU
46
LENAWEE
47
4390138
00HU
47
LIVINGSTON
48
1724945
00HJ
48
LUCE
200
238
286
49
1724945
00HJ
49
MACKINAC
173
222
379
50
3396315
00GX
50
MACOMB
9,019
13,133
24,330
31,574
51
1708001
00BJ
51
MANISTEE
492
654
1,038
52
1724945
00HJ
52
MARQUETTE
936
1,369
2,009
53
4540048
00HC
53
MASON
544
701
1,361
1,743
54
4344340
00GG
54
MECOSTA
781
1,068
1,953
55
1724945
00HJ
55
MENOMINEE
383
565
831
56
4344340
00GG
56
MIDLAND
1,280
1,614
2,894
57
4540048
00HC
57
MISSAUKEE
235
279
640
58
4390138
00HU
58
MONROE
1,656
2,382
4,304
Code
County Name
Report Generated: 10/15/2007
12:47 PM
Male
Female
Male
Female
Total
Male
Female
Male
Female
126
168
405
481
1,180
$
407
$
339
$
378
$
658
$
1,782
1,341
1,862
3,625
4,589
11,417
$
5,256
$
4,771
$
3,825
$
7,313
$
21,164
912
1,188
2,925
3,644
8,669
$
3,342
$
2,882
$
2,930
$
5,920
$
15,074
355
1,079
$
652
$
471
$
294
$
539
$
1,957
426
1,200
$
592
$
482
$
375
$
618
$
2,067
78,056
$
65,563
$
58,356
$
30,929
$
65,671
$
220,520
1,263
3,447
$
1,497
$
1,291
$
861
$
1,501
$
5,150
2,471
6,785
$
3,457
$
2,992
$
2,163
$
4,290
$
12,902
4,349
$
1,964
$
1,719
$
1,313
$
2,522
$
7,518
2,471
6,273
$
2,780
$
2,672
$
1,797
$
3,132
$
10,382
1,081
2,860
$
1,207
$
1,061
$
907
$
1,684
$
4,859
3,709
9,497
$
4,685
$
3,559
$
2,358
$
4,487
$
15,090
789
1,943
$
804
$
601
$
665
$
1,140
$
3,209
5,797
14,139
$
6,580
$
6,090
$
4,550
$
9,827
$
27,047
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA by County
Page 24 of 79
Substance Abuse - Capitation by County
October, 2007
Summary by Population Group and Gender
Revenue - Substance Abuse - State Plan and 1915(b)(3)
Paid Population
TANF
DAB
DAB Capitation
Provider ID
Billing
Agent
59
1705322
00GE
59
MONTCALM
60
4476125
00HF
60
MONTMORENCY
61
1712452
00HA
61
MUSKEGON
62
1708001
00BJ
62
NEWAYGO
1,040
1,325
2,415
63
1705289
0058
63
OAKLAND
11,712
16,570
24,318
64
4540048
00HC
64
OCEANA
555
694
1,948
65
4476125
00HF
65
OGEMAW
607
723
66
1724945
00HJ
66
ONTONAGON
161
243
67
4344340
00GG
67
OSCEOLA
517
588
68
4476125
00HF
68
OSCODA
249
315
449
69
4476125
00HF
69
OTSEGO
411
520
1,226
70
1712452
00HA
70
OTTAWA
1,859
2,657
6,724
7,851
71
4476125
00HF
71
PRESQUE ISLE
251
339
481
72
4540048
00HC
72
ROSCOMMON
671
833
1,283
73
1712541
00HQ
73
SAGINAW
5,172
6,219
10,105
74
1708164
00HO
74
ST CLAIR
2,497
3,129
75
3402136
00GR
75
ST JOSEPH
1,104
1,464
76
1708164
00HO
76
SANILAC
796
1,006
77
1724945
00HJ
77
SCHOOLCRAFT
78
1705322
00GE
78
SHIAWASSEE
79
1705322
00GE
79
TUSCOLA
80
2920843
00HR
80
81
4390138
00HU
81
82
3119549
00GJ
82
WAYNE
83
4540048
00HC
83
WEXFORD
Code
County Name
Male
Female
Male
Female
Total
Male
TANF Capitation
Female
Male
Total Capitation
Female
1,199
1,378
3,157
3,852
9,586
$
4,508
$
3,458
$
4,146
$
7,013
$
19,125
248
306
467
588
1,609
$
1,045
$
789
$
553
$
957
$
3,344
4,189
5,679
9,742
13,161
32,771
$
19,978
$
18,434
$
10,780
$
23,436
$
72,628
2,890
7,670
$
3,098
$
2,563
$
1,985
$
3,410
$
11,057
31,742
84,342
$
63,658
$
53,311
$
24,868
$
56,803
$
198,640
2,163
5,360
$
2,232
$
1,618
$
2,019
$
2,872
$
8,741
1,295
1,581
4,206
$
2,689
$
1,999
$
1,614
$
2,644
$
8,947
270
339
1,013
$
545
$
453
$
348
$
494
$
1,841
1,093
1,377
3,575
$
1,836
$
1,422
$
942
$
1,667
$
5,867
523
1,536
$
1,108
$
797
$
547
$
786
$
3,237
1,633
3,790
$
1,652
$
1,272
$
1,372
$
2,611
$
6,907
19,091
$
7,849
$
7,637
$
5,798
$
10,946
$
32,231
591
1,662
$
976
$
724
$
387
$
709
$
2,796
1,569
4,356
$
2,791
$
2,204
$
1,547
$
2,686
$
9,228
14,392
35,888
$
32,230
$
26,791
$
10,963
$
28,086
$
98,070
6,735
8,703
21,064
$
8,978
$
7,526
$
8,760
$
17,682
$
42,946
3,060
3,889
9,517
$
5,519
$
4,877
$
3,117
$
6,012
$
19,525
2,191
2,845
6,838
$
2,959
$
2,026
$
2,991
$
5,256
$
13,232
204
277
425
506
1,412
$
792
$
569
$
477
$
752
$
2,590
1,053
1,397
3,174
3,932
9,556
$
3,835
$
3,283
$
4,311
$
7,882
$
19,310
998
1,181
2,606
3,231
8,016
$
3,641
$
2,731
$
3,402
$
5,915
$
15,688
VAN BUREN
1,607
2,019
4,132
4,996
12,754
$
5,463
$
4,374
$
4,194
$
7,006
$
21,037
WASHTENAW
3,243
4,145
7,349
9,933
24,670
$
12,395
$
10,408
$
7,446
$
17,928
$
48,177
53,187
63,990
113,629
160,105
390,911
$
397,720
$
301,958
$
63,680
$
177,829
$
941,186
770
923
1,852
2,419
5,964
$
2,938
$
2,401
$
1,792
$
3,629
$
10,760
174,659
222,725
404,253
536,878
1,338,515
$
967,505
$
788,329
$
375,316
$
829,539
$
2,960,690
2,960,690
$
2,960,690
State Subtotals
397,384
941,131
-
-
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SA by County
Page 25 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - DAB - Male
M
DAB
October, 2007
Detail by Gender by Population by Age Group
Population - by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
1,227
883
939
1,053
1,341
914
6,357
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
2,477
1,404
1,423
1,405
1,907
1,407
10,023
3
4344340
00GG
CMH for Central Michigan
M
DAB
1,001
727
677
833
1,051
667
4,956
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
2,777
1,590
1,445
1,326
1,798
1,364
10,300
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
12,383
6,292
7,087
8,048
12,145
7,232
53,187
6
1705233
0028
Genesee County CMH Services
M
DAB
2,655
1,351
1,433
1,625
1,937
826
9,827
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
1,503
871
898
935
1,119
722
6,048
8
1712229
00GV
Lifeways
M
DAB
1,002
482
566
545
727
473
3,795
00GX
Macomb County CMH Services
M
DAB
1,903
1,256
1,118
1,224
1,630
1,888
9,019
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
845
644
707
870
1,161
1,256
5,483
11
4476125
00HF
Northern Affiliation
M
DAB
957
681
638
842
1,203
1,006
5,327
12
4540048
00HC
Northern Lakes
M
DAB
981
608
567
759
1,038
824
4,777
13
1705289
0058
Oakland County CMH Authority
M
DAB
2,392
1,437
1,576
1,556
2,109
2,642
11,712
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
1,408
666
754
842
948
554
5,172
15
4390138
00HU
Southeast Partnership
M
DAB
1,633
1,073
1,086
1,032
1,303
1,025
7,152
16
3402136
00GR
Southwest Alliance
M
DAB
1,930
995
1,021
1,103
1,525
959
7,533
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
925
574
586
622
858
607
4,172
18
2920843
00HR
Venture Behavioral Health
M
DAB
2,510
1,243
1,273
1,438
1,920
1,435
9,819
-
19
20
State Subtotals
40,509
22,777
23,794
26,058
35,720
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
25,801
174,659
-
Page 26 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - DAB - Female
F
DAB
October, 2007
Detail by Gender by Population by Age Group
Population - by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
815
702
924
1,149
1,915
2,535
8,040
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
1,743
1,268
1,444
1,769
2,951
3,728
12,903
3
4344340
00GG
CMH for Central Michigan
F
DAB
727
651
690
978
1,507
1,739
6,292
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
1,812
1,263
1,687
1,776
2,585
3,337
12,460
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
8,591
5,375
6,756
8,472
16,634
18,162
63,990
6
1705233
0028
Genesee County CMH Services
F
DAB
1,884
1,135
1,616
2,025
2,872
2,547
12,079
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
1,082
816
1,027
1,219
1,929
2,263
8,336
8
1712229
00GV
Lifeways
F
DAB
719
402
567
628
1,073
1,188
4,577
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
1,381
1,078
1,194
1,501
2,939
5,040
13,133
10
1724945
00HJ
Northcare
F
DAB
568
574
689
928
1,696
3,490
7,945
11
4476125
00HF
Northern Affiliation
F
DAB
667
509
708
939
1,716
2,479
7,018
12
4540048
00HC
Northern Lakes
F
DAB
634
495
656
874
1,493
1,927
6,079
13
1705289
0058
Oakland County CMH Authority
F
DAB
1,899
1,185
1,542
1,849
3,384
6,711
16,570
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
899
561
824
904
1,477
1,554
6,219
15
4390138
00HU
Southeast Partnership
F
DAB
1,174
933
1,116
1,292
2,106
2,956
9,577
16
3402136
00GR
Southwest Alliance
F
DAB
1,343
878
1,168
1,369
2,188
2,630
9,576
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
670
462
554
726
1,270
1,628
5,310
18
2920843
00HR
Venture Behavioral Health
F
DAB
1,755
1,050
1,406
1,713
2,977
3,720
12,621
-
19
20
State Subtotals
28,363
19,337
24,568
30,111
52,712
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
67,634
222,725
-
Page 27 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - TANF - Male
M
TANF
October, 2007
Detail by Gender by Population by Age Group
Population - by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
13,555
895
947
440
97
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
20,948
1,102
1,265
523
155
3
4344340
00GG
CMH for Central Michigan
M
TANF
9,373
647
774
357
93
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
22,376
1,056
864
430
128
1
24,855
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
101,146
5,777
3,487
2,281
919
19
113,629
6
1705233
0028
Genesee County CMH Services
M
TANF
20,340
1,174
1,319
538
124
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
14,657
748
695
295
71
8
1712229
00GV
Lifeways
M
TANF
7,759
417
403
177
43
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
-
15,934
3
-
23,996
11,244
1
-
23,496
16,466
1
7
8,800
9
3396315
00GX
Macomb County CMH Services
M
TANF
21,054
1,190
1,051
703
325
10
1724945
00HJ
Northcare
M
TANF
10,115
624
589
276
70
11
4476125
00HF
Northern Affiliation
M
TANF
10,950
690
711
352
94
12
4540048
00HC
Northern Lakes
M
TANF
10,076
624
668
276
13
1705289
0058
Oakland County CMH Authority
M
TANF
21,680
1,103
805
503
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
8,867
484
491
205
58
15
4390138
00HU
Southeast Partnership
M
TANF
16,052
882
799
363
106
16
3402136
00GR
Southwest Alliance
M
TANF
16,181
852
883
365
89
-
18,370
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
10,322
624
650
319
96
-
12,011
18
2920843
00HR
Venture Behavioral Health
M
TANF
19,549
1,018
1,093
497
144
-
24,330
11,674
1
12,798
77
1
11,722
224
3
24,318
-
10,105
1
1
18,203
22,302
-
19
20
State Subtotals
355,000
19,907
17,494
8,900
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
2,913
39
404,253
-
Page 28 of 79
Mental Health/Substance Abuse Population - PIHP by Age Group - TANF - Female
F
TANF
October, 2007
Detail by Gender by Population by Age Group
Population - by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
13,258
2,808
3,077
807
125
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
20,384
4,030
4,964
1,238
209
3
4344340
00GG
CMH for Central Michigan
F
TANF
9,103
2,046
2,385
648
96
-
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
21,949
4,153
4,637
1,167
215
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
100,330
20,353
28,409
8,895
2,102
16
160,105
6
1705233
0028
Genesee County CMH Services
F
TANF
20,389
4,640
6,135
1,533
259
3
32,959
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
14,124
2,937
3,138
692
119
2
21,012
8
1712229
00GV
Lifeways
F
TANF
7,771
1,547
1,658
395
72
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
-
20,075
1
30,826
14,278
32,121
-
11,443
9
3396315
00GX
Macomb County CMH Services
F
TANF
20,357
3,896
5,234
1,704
381
10
1724945
00HJ
Northcare
F
TANF
9,490
1,974
2,148
601
95
-
2
14,308
31,574
11
4476125
00HF
Northern Affiliation
F
TANF
10,749
1,987
2,218
635
100
-
15,689
12
4540048
00HC
Northern Lakes
F
TANF
9,831
1,889
2,114
565
111
1
14,511
13
1705289
0058
Oakland County CMH Authority
F
TANF
21,328
3,659
4,848
1,553
351
3
31,742
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
9,053
1,943
2,578
697
121
-
15
4390138
00HU
Southeast Partnership
F
TANF
15,845
3,182
3,801
951
184
-
16
3402136
00GR
Southwest Alliance
F
TANF
15,945
3,234
3,738
839
172
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
9,964
2,037
2,469
666
115
18
2920843
00HR
Venture Behavioral Health
F
TANF
19,239
3,913
4,274
1,067
205
14,392
23,963
1
-
23,929
15,251
2
28,700
-
19
20
State Subtotals
349,109
70,228
87,825
24,653
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSA-Pop
5,032
31
536,878
-
Page 29 of 79
Mental Health - Revenue by PIHP by Age Group - State Plan - DAB - Male
M
DAB
October, 2007
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
73,829
$
120,265
$
252,544
$
287,890
$
278,378
$
53,423
$
1,066,329
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
137,201
$
176,034
$
352,306
$
353,596
$
364,428
$
75,697
$
1,459,262
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
52,272
$
85,946
$
158,032
$
197,663
$
189,369
$
33,837
$
717,119
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
167,953
$
217,687
$
390,656
$
364,425
$
375,207
$
80,135
$
1,596,062
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
579,772
$
666,826
$
1,483,167
$
1,712,132
$
1,961,782
$
328,911
$
6,732,590
6
1705233
0028
Genesee County CMH Services
M
DAB
$
151,388
$
174,374
$
365,214
$
420,989
$
381,027
$
45,744
$
1,538,736
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
92,870
$
121,827
$
248,028
$
262,520
$
238,560
$
43,334
$
1,007,139
8
1712229
00GV
Lifeways
M
DAB
$
53,928
$
58,722
$
136,163
$
133,280
$
134,997
$
24,728
$
541,817
00GX
Macomb County CMH Services
M
DAB
$
192,393
$
287,448
$
505,235
$
562,281
$
568,560
$
185,420
$
2,301,339
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
66,730
$
115,121
$
249,564
$
312,182
$
316,326
$
96,348
$
1,156,271
11
4476125
00HF
Northern Affiliation
M
DAB
$
41,256
$
66,459
$
122,943
$
164,931
$
178,934
$
42,131
$
616,654
12
4540048
00HC
Northern Lakes
M
DAB
$
54,661
$
76,687
$
141,223
$
192,171
$
199,556
$
44,603
$
708,901
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
270,463
$
367,800
$
796,526
$
799,426
$
822,742
$
290,171
$
3,347,129
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
67,739
$
72,541
$
162,163
$
184,078
$
157,368
$
25,894
$
669,782
15
4390138
00HU
Southeast Partnership
M
DAB
$
106,831
$
158,901
$
317,579
$
306,772
$
294,100
$
65,139
$
1,249,322
16
3402136
00GR
Southwest Alliance
M
DAB
$
119,506
$
139,469
$
282,603
$
310,351
$
325,816
$
57,684
$
1,235,429
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
83,444
$
117,217
$
236,305
$
254,970
$
267,053
$
53,191
$
1,012,179
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
113,879
$
127,656
$
258,152
$
296,429
$
300,518
$
63,240
$
1,159,875
$
2,426,115
$
3,150,978
$
6,458,401
$
7,116,086
$
7,354,720
$
1,609,632
$
28,115,933
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSP-DAB
-
Page 30 of 79
Mental Health - Revenue by PIHP by Age Group - State Plan - DAB - Female
F
DAB
October, 2007
Detail
Revenue for DAB Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
34,108
$
72,783
$
186,676
$
232,270
$
274,151
$
81,602
$
881,590
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
67,158
$
121,018
$
268,555
$
329,193
$
388,883
$
110,461
$
1,285,267
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
26,412
$
58,583
$
120,992
$
171,600
$
187,245
$
48,570
$
613,402
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
76,231
$
131,630
$
342,613
$
360,901
$
371,982
$
107,952
$
1,391,308
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
279,809
$
433,655
$
1,062,111
$
1,332,646
$
1,852,861
$
454,776
$
5,415,858
6
1705233
0028
Genesee County CMH Services
F
DAB
$
74,719
$
111,514
$
309,383
$
387,909
$
389,587
$
77,684
$
1,350,796
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
46,504
$
86,880
$
213,082
$
253,064
$
283,582
$
74,792
$
957,905
8
1712229
00GV
Lifeways
F
DAB
$
26,919
$
37,281
$
102,468
$
113,555
$
137,398
$
34,203
$
451,824
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
$
97,112
$
187,798
$
405,327
$
509,845
$
706,947
$
272,563
$
2,179,592
10
1724945
00HJ
Northcare
F
DAB
$
31,200
$
78,110
$
182,702
$
246,217
$
318,661
$
147,418
$
1,004,308
11
4476125
00HF
Northern Affiliation
F
DAB
$
20,003
$
37,809
$
102,483
$
136,005
$
176,010
$
57,166
$
529,475
12
4540048
00HC
Northern Lakes
F
DAB
$
24,574
$
47,525
$
122,738
$
163,622
$
197,927
$
57,444
$
613,829
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
149,356
$
230,874
$
585,436
$
702,398
$
910,364
$
405,881
$
2,984,309
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
30,090
$
46,513
$
133,125
$
146,132
$
169,087
$
40,000
$
564,946
15
4390138
00HU
Southeast Partnership
F
DAB
$
53,429
$
105,177
$
245,152
$
283,982
$
327,799
$
103,430
$
1,118,968
16
3402136
00GR
Southwest Alliance
F
DAB
$
57,843
$
93,683
$
242,862
$
284,820
$
322,358
$
87,106
$
1,088,672
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
42,043
$
71,818
$
167,818
$
220,043
$
272,593
$
78,567
$
852,882
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
55,388
$
82,079
$
214,176
$
261,095
$
321,337
$
90,284
$
1,024,360
$
1,192,898
$
2,034,728
$
5,007,698
$
6,135,297
$
7,608,772
$
2,329,899
$
24,309,291
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSP-DAB
-
Page 31 of 79
Mental Health - Revenue by PIHP by Age Group - State Plan - TANF - Male
M
TANF
October, 2007
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
201,834
$
14,275
$
16,809
$
9,108
$
1,396
$
-
$
243,422
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
263,526
$
14,855
$
18,975
$
9,147
$
1,885
$
-
$
308,388
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
113,882
$
8,424
$
11,215
$
6,030
$
1,092
$
-
$
140,643
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
165,582
$
8,364
$
7,620
$
4,420
$
915
$
-
$
186,902
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
730,274
$
44,656
$
29,988
$
22,878
$
6,405
$
-
$
834,203
6
1705233
0028
Genesee County CMH Services
M
TANF
$
141,770
$
8,758
$
10,961
$
5,208
$
835
$
-
$
167,531
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
92,339
$
5,049
$
5,219
$
2,584
$
432
$
-
$
105,624
8
1712229
00GV
Lifeways
M
TANF
$
83,875
$
4,829
$
5,195
$
2,660
$
449
$
-
$
97,008
00GX
Macomb County CMH Services
M
TANF
$
216,435
$
13,114
$
12,885
$
10,053
$
3,231
$
-
$
255,718
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
191,275
$
12,642
$
13,282
$
7,256
$
1,280
$
-
$
225,734
11
4476125
00HF
Northern Affiliation
M
TANF
$
86,505
$
5,837
$
6,698
$
3,865
$
717
$
-
$
103,622
12
4540048
00HC
Northern Lakes
M
TANF
$
149,528
$
9,922
$
11,824
$
5,697
$
1,105
$
-
$
178,075
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
287,910
$
15,696
$
12,751
$
9,290
$
2,876
$
-
$
328,524
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
45,222
$
2,643
$
2,985
$
1,453
$
286
$
-
$
52,589
15
4390138
00HU
Southeast Partnership
M
TANF
$
161,804
$
9,526
$
9,604
$
5,089
$
1,034
$
-
$
187,057
16
3402136
00GR
Southwest Alliance
M
TANF
$
159,868
$
9,023
$
10,402
$
5,015
$
850
$
-
$
185,158
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
164,946
$
10,683
$
12,389
$
7,088
$
1,483
$
-
$
196,589
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
155,415
$
8,673
$
10,362
$
5,492
$
1,106
$
-
$
181,047
$
3,411,989
$
206,968
$
209,164
$
122,335
$
27,376
$
-
$
3,977,833
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSP-TANF
-
Page 32 of 79
Mental Health - Revenue by PIHP by Age Group - State Plan - TANF - Female
F
TANF
October, 2007
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
137,088
$
40,211
$
65,971
$
25,235
$
3,605
$
-
$
272,109
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
178,156
$
48,763
$
89,948
$
32,720
$
5,095
$
-
$
354,683
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
76,829
$
23,918
$
41,738
$
16,537
$
2,260
$
-
$
161,281
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
112,818
$
29,569
$
49,430
$
18,135
$
3,081
$
-
$
213,034
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
502,653
$
141,250
$
295,170
$
134,848
$
29,386
$
-
$
1,103,307
6
1705233
0028
Genesee County CMH Services
F
TANF
$
98,683
$
31,088
$
61,534
$
22,428
$
3,497
$
-
$
217,229
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
61,863
$
17,798
$
28,493
$
9,162
$
1,453
$
-
$
118,769
8
1712229
00GV
Lifeways
F
TANF
$
58,360
$
16,089
$
25,815
$
8,967
$
1,508
$
-
$
110,738
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
TANF
$
145,349
$
38,531
$
77,516
$
36,806
$
7,593
$
-
$
305,796
10
1724945
00HJ
Northcare
F
TANF
$
124,699
$
35,907
$
58,512
$
23,872
$
3,481
$
-
$
246,470
11
4476125
00HF
Northern Affiliation
F
TANF
$
59,012
$
15,101
$
25,241
$
10,535
$
1,530
$
-
$
111,419
12
4540048
00HC
Northern Lakes
F
TANF
$
101,358
$
26,975
$
45,197
$
17,617
$
3,192
$
-
$
194,339
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
196,857
$
46,762
$
92,742
$
43,329
$
9,031
$
-
$
388,722
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
32,048
$
9,521
$
18,923
$
7,465
$
1,195
$
-
$
69,151
15
4390138
00HU
Southeast Partnership
F
TANF
$
111,073
$
30,865
$
55,229
$
20,142
$
3,595
$
-
$
220,905
16
3402136
00GR
Southwest Alliance
F
TANF
$
109,542
$
30,755
$
53,229
$
17,418
$
3,294
$
-
$
214,238
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
110,700
$
31,329
$
56,836
$
22,358
$
3,562
$
-
$
224,785
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
106,199
$
29,934
$
48,937
$
17,819
$
3,157
$
-
$
206,047
$
2,323,288
$
644,367
$
1,190,459
$
485,391
$
89,515
$
-
$
4,733,021
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHSP-TANF
-
Page 33 of 79
Mental Health - Revenue by PIHP by Age Group - 1915(b)(3) - DAB - Male
M
DAB
October, 2007
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
2
1708001
3
4344340
4
4483587
00GS
5
3119549
00GJ
Detroit Wayne County CMH Agency
6
1705233
0028
Genesee County CMH Services
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
8
1712229
00GV
Lifeways
9
3396315
00GX
Macomb County CMH Services
10
1724945
00HJ
Northcare
M
11
4476125
00HF
Northern Affiliation
12
4540048
00HC
Northern Lakes
13
1705289
0058
Oakland County CMH Authority
14
1712541
00HQ
15
4390138
00HU
16
3402136
00GR
Southwest Alliance
17
1708164
00HO
Thumb Mental Health Alliance
18
2920843
00HR
Venture Behavioral Health
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
Access Alliance of Michigan
M
DAB
$
62,663
$
102,084
$
214,355
$
244,359
$
236,284
$
45,344
$
905,088
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
116,444
$
149,414
$
299,029
$
300,136
$
309,315
$
64,258
$
1,238,596
00GG
CMH for Central Michigan
M
DAB
$
44,374
$
72,947
$
134,141
$
167,775
$
160,729
$
28,721
$
608,687
CMHSA Network of West Michigan
M
DAB
$
142,571
$
184,774
$
331,584
$
309,316
$
318,462
$
68,023
$
1,354,730
M
DAB
$
492,100
$
566,028
$
1,258,864
$
1,453,227
$
1,665,201
$
279,155
$
5,714,576
M
DAB
$
128,502
$
148,002
$
309,987
$
357,338
$
323,421
$
38,830
$
1,306,079
DAB
$
78,832
$
103,405
$
210,518
$
222,820
$
202,483
$
36,786
$
854,844
M
DAB
$
45,771
$
49,844
$
115,577
$
113,126
$
114,582
$
20,992
$
459,892
M
DAB
$
163,296
$
243,978
$
428,831
$
477,262
$
482,594
$
157,384
$
1,953,346
DAB
$
56,640
$
97,714
$
211,824
$
264,976
$
268,493
$
81,778
$
981,426
M
DAB
$
35,017
$
56,407
$
104,351
$
139,991
$
151,879
$
35,753
$
523,398
M
DAB
$
46,401
$
65,092
$
119,869
$
163,109
$
169,381
$
37,855
$
601,708
M
DAB
$
229,560
$
312,188
$
676,088
$
678,540
$
698,332
$
246,314
$
2,841,023
Saginaw County CMH Authority
M
DAB
$
57,503
$
61,572
$
137,643
$
156,250
$
133,573
$
21,977
$
568,517
Southeast Partnership
M
DAB
$
90,680
$
134,876
$
269,556
$
260,384
$
249,629
$
55,289
$
1,060,414
M
DAB
$
101,441
$
118,385
$
239,874
$
263,418
$
276,544
$
48,967
$
1,048,628
M
DAB
$
70,827
$
99,497
$
200,570
$
216,412
$
226,675
$
45,149
$
859,131
M
DAB
$
96,660
$
108,352
$
219,109
$
251,607
$
255,091
$
53,683
$
984,503
$
2,059,285
$
2,674,560
$
5,481,771
$
6,040,046
$
6,242,668
$
1,366,256
$
23,864,586
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHB3-DAB
-
Page 34 of 79
Mental Health - Revenue by PIHP by Age Group - 1915(b)(3) - DAB - Female
F
DAB
October, 2007
Detail
Revenue for DAB Female by Age Group
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
2
1708001
3
4344340
4
4483587
00GS
5
3119549
00GJ
Detroit Wayne County CMH Agency
6
1705233
0028
Genesee County CMH Services
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
8
1712229
00GV
Lifeways
9
3396315
00GX
Macomb County CMH Services
10
1724945
00HJ
Northcare
F
11
4476125
00HF
Northern Affiliation
12
4540048
00HC
Northern Lakes
13
1705289
0058
Oakland County CMH Authority
14
1712541
00HQ
15
4390138
00HU
16
3402136
00GR
Southwest Alliance
17
1708164
00HO
Thumb Mental Health Alliance
18
2920843
00HR
Venture Behavioral Health
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
Access Alliance of Michigan
F
DAB
$
28,949
$
61,776
$
158,448
$
197,145
$
232,692
$
69,256
$
748,266
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
56,996
$
102,721
$
227,950
$
279,414
$
330,099
$
93,759
$
1,090,938
00GG
CMH for Central Michigan
F
DAB
$
22,413
$
49,723
$
102,700
$
145,654
$
158,928
$
41,232
$
520,650
CMHSA Network of West Michigan
F
DAB
$
64,707
$
111,725
$
290,805
$
306,324
$
315,758
$
91,634
$
1,180,953
F
DAB
$
237,455
$
368,080
$
901,521
$
1,131,181
$
1,572,745
$
386,124
$
4,597,106
F
DAB
$
63,415
$
94,648
$
262,600
$
329,245
$
330,682
$
65,942
$
1,146,532
DAB
$
39,471
$
73,742
$
180,865
$
214,800
$
240,701
$
63,477
$
813,056
F
DAB
$
22,850
$
31,645
$
86,972
$
96,385
$
116,624
$
29,035
$
383,512
F
DAB
$
82,432
$
159,404
$
344,039
$
432,753
$
600,056
$
231,336
$
1,850,020
DAB
$
26,480
$
66,297
$
155,073
$
208,986
$
270,478
$
125,117
$
852,431
F
DAB
$
16,975
$
32,092
$
86,992
$
115,441
$
149,395
$
48,514
$
449,409
F
DAB
$
20,859
$
40,343
$
104,179
$
138,879
$
168,007
$
48,753
$
521,019
F
DAB
$
126,777
$
195,963
$
496,925
$
596,192
$
772,703
$
344,543
$
2,533,102
Saginaw County CMH Authority
F
DAB
$
25,541
$
39,478
$
112,995
$
124,038
$
143,520
$
33,955
$
479,526
Southeast Partnership
F
DAB
$
45,340
$
89,269
$
208,078
$
241,036
$
278,245
$
87,793
$
949,761
F
DAB
$
49,100
$
79,520
$
206,140
$
241,752
$
273,609
$
73,956
$
924,078
F
DAB
$
35,684
$
60,956
$
142,439
$
186,771
$
231,381
$
66,683
$
723,914
F
DAB
$
46,999
$
69,668
$
181,796
$
221,611
$
272,753
$
76,632
$
869,458
$
1,012,443
$
1,727,051
$
4,250,517
$
5,207,605
$
6,458,375
$
1,977,740
$
20,633,731
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHB3-DAB
-
Page 35 of 79
Mental Health - Revenue by PIHP by Age Group - 1915(b)(3) - TANF - Male
M
TANF
October, 2007
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
31,448
$
2,220
$
2,614
$
1,417
$
217
$
-
$
37,915
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
41,058
$
2,314
$
2,960
$
1,423
$
293
$
-
$
48,048
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
17,715
$
1,313
$
1,749
$
939
$
170
$
-
$
21,887
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
25,732
$
1,299
$
1,184
$
688
$
142
$
-
$
29,045
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
113,284
$
6,932
$
4,673
$
3,558
$
1,002
$
-
$
129,449
6
1705233
0028
Genesee County CMH Services
M
TANF
$
21,967
$
1,362
$
1,702
$
812
$
130
$
-
$
25,973
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
14,364
$
785
$
813
$
401
$
67
$
-
$
16,431
8
1712229
00GV
Lifeways
M
TANF
$
13,035
$
751
$
810
$
414
$
70
$
-
$
15,080
00GX
Macomb County CMH Services
M
TANF
$
33,686
$
2,035
$
2,007
$
1,568
$
504
$
-
$
39,800
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
29,738
$
1,966
$
2,067
$
1,129
$
200
$
-
$
35,099
11
4476125
00HF
Northern Affiliation
M
TANF
$
13,469
$
911
$
1,045
$
602
$
112
$
-
$
16,138
12
4540048
00HC
Northern Lakes
M
TANF
$
23,276
$
1,548
$
1,844
$
886
$
172
$
-
$
27,724
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
44,878
$
2,438
$
1,988
$
1,444
$
448
$
-
$
51,195
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
7,005
$
411
$
466
$
226
$
45
$
-
$
8,153
15
4390138
00HU
Southeast Partnership
M
TANF
$
25,202
$
1,482
$
1,494
$
791
$
161
$
-
$
29,130
16
3402136
00GR
Southwest Alliance
M
TANF
$
24,919
$
1,406
$
1,616
$
781
$
133
$
-
$
28,854
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
25,702
$
1,666
$
1,931
$
1,104
$
230
$
-
$
30,633
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
24,241
$
1,354
$
1,618
$
855
$
173
$
-
$
28,240
$
530,717
$
32,192
$
32,581
$
19,037
$
4,268
$
-
$
618,795
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHB3-TANF
0
Page 36 of 79
Mental Health - Revenue by PIHP by Age Group - 1915(b)(3) - TANF - Female
F
TANF
October, 2007
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
21,345
$
6,262
$
10,277
$
3,930
$
561
$
-
$
42,376
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
27,722
$
7,576
$
13,998
$
5,088
$
794
$
-
$
55,180
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
11,925
$
3,724
$
6,487
$
2,573
$
351
$
-
$
25,060
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
17,559
$
4,610
$
7,697
$
2,824
$
479
$
-
$
33,170
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
78,257
$
21,981
$
46,023
$
20,992
$
4,582
$
-
$
171,836
6
1705233
0028
Genesee County CMH Services
F
TANF
$
15,292
$
4,826
$
9,571
$
3,495
$
544
$
-
$
33,727
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
9,604
$
2,761
$
4,425
$
1,426
$
226
$
-
$
18,441
8
1712229
00GV
Lifeways
F
TANF
$
9,092
$
2,506
$
4,012
$
1,394
$
235
$
-
$
17,240
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
TANF
$
22,596
$
6,000
$
12,091
$
5,725
$
1,181
$
-
$
47,593
10
1724945
00HJ
Northcare
F
TANF
$
19,455
$
5,586
$
9,108
$
3,714
$
542
$
-
$
38,404
11
4476125
00HF
Northern Affiliation
F
TANF
$
9,137
$
2,345
$
3,926
$
1,638
$
238
$
-
$
17,283
12
4540048
00HC
Northern Lakes
F
TANF
$
15,828
$
4,194
$
7,040
$
2,740
$
497
$
-
$
30,299
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
30,712
$
7,281
$
14,447
$
6,740
$
1,408
$
-
$
60,588
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
4,979
$
1,477
$
2,939
$
1,164
$
186
$
-
$
10,745
15
4390138
00HU
Southeast Partnership
F
TANF
$
17,271
$
4,805
$
8,590
$
3,138
$
559
$
-
$
34,364
16
3402136
00GR
Southwest Alliance
F
TANF
$
17,061
$
4,786
$
8,298
$
2,710
$
513
$
-
$
33,368
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
17,238
$
4,868
$
8,839
$
3,483
$
554
$
-
$
34,983
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
16,546
$
4,656
$
7,608
$
2,774
$
492
$
-
$
32,076
$
361,620
$
100,244
$
185,375
$
75,550
$
13,943
$
-
$
736,733
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
MHB3-TANF
(0)
Page 37 of 79
Substance Abuse - Revenue by PIHP by Age Group - State Plan - DAB - Male
M
DAB
October, 2007
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
896
$
2,093
$
2,676
$
5,191
$
6,088
$
320
$
17,264
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
1,486
$
2,752
$
3,344
$
5,718
$
7,151
$
408
$
20,860
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
701
$
1,672
$
1,869
$
3,982
$
4,635
$
227
$
13,085
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
2,971
$
5,565
$
6,083
$
9,640
$
12,047
$
696
$
37,002
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
18,079
$
29,950
$
40,538
$
79,595
$
110,641
$
5,062
$
283,865
6
1705233
0028
Genesee County CMH Services
M
DAB
$
3,558
$
5,904
$
7,523
$
14,755
$
16,193
$
529
$
48,462
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
1,383
$
2,622
$
3,242
$
5,844
$
6,445
$
318
$
19,853
8
1712229
00GV
Lifeways
M
DAB
$
772
$
1,205
$
1,704
$
2,839
$
3,490
$
175
$
10,184
00GX
Macomb County CMH Services
M
DAB
$
2,988
$
6,443
$
6,887
$
13,048
$
16,007
$
1,416
$
46,788
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
608
$
1,507
$
1,987
$
4,228
$
5,201
$
427
$
13,959
11
4476125
00HF
Northern Affiliation
M
DAB
$
756
$
1,764
$
1,984
$
4,538
$
5,967
$
382
$
15,392
12
4540048
00HC
Northern Lakes
M
DAB
$
736
$
1,490
$
1,667
$
3,863
$
4,868
$
297
$
12,921
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
2,846
$
5,561
$
7,328
$
12,526
$
15,649
$
1,506
$
45,417
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
1,760
$
2,711
$
3,687
$
7,123
$
7,394
$
332
$
23,008
15
4390138
00HU
Southeast Partnership
M
DAB
$
1,290
$
2,747
$
3,345
$
5,501
$
6,398
$
390
$
19,670
16
3402136
00GR
Southwest Alliance
M
DAB
$
2,046
$
3,443
$
4,247
$
7,931
$
10,096
$
489
$
28,251
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
666
$
1,343
$
1,647
$
3,023
$
3,844
$
206
$
10,729
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
1,757
$
2,834
$
3,488
$
6,831
$
8,390
$
474
$
23,774
$
45,298
$
81,604
$
103,246
$
196,176
$
250,504
$
13,653
$
690,481
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SASP-DAB
-
Page 38 of 79
Substance Abuse - Revenue by PIHP by Age Group - State Plan - DAB - Female
F
DAB
October, 2007
Detail
Revenue for DAB Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
302
$
1,207
$
3,058
$
5,079
$
3,945
$
127
$
13,718
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
540
$
1,801
$
3,942
$
6,457
$
5,017
$
149
$
17,906
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
262
$
1,087
$
2,215
$
4,196
$
3,014
$
70
$
10,843
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
997
$
3,208
$
8,233
$
11,580
$
7,884
$
234
$
32,135
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
6,443
$
18,544
$
44,860
$
75,147
$
68,865
$
1,635
$
215,493
6
1705233
0028
Genesee County CMH Services
F
DAB
$
1,281
$
3,598
$
9,841
$
16,484
$
10,914
$
204
$
42,321
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
509
$
1,779
$
4,313
$
6,826
$
5,054
$
136
$
18,617
8
1712229
00GV
Lifeways
F
DAB
$
280
$
732
$
1,985
$
2,933
$
2,339
$
59
$
8,328
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
$
1,105
$
4,010
$
8,549
$
14,350
$
13,137
$
504
$
41,655
10
1724945
00HJ
Northcare
F
DAB
$
210
$
976
$
2,246
$
4,046
$
3,460
$
175
$
11,113
11
4476125
00HF
Northern Affiliation
F
DAB
$
273
$
957
$
2,563
$
4,535
$
3,878
$
124
$
12,331
12
4540048
00HC
Northern Lakes
F
DAB
$
241
$
876
$
2,244
$
3,985
$
3,180
$
96
$
10,622
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
1,158
$
3,330
$
8,327
$
13,350
$
11,404
$
470
$
38,039
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
575
$
1,655
$
4,680
$
6,861
$
5,229
$
124
$
19,125
15
4390138
00HU
Southeast Partnership
F
DAB
$
470
$
1,735
$
3,995
$
6,176
$
4,696
$
148
$
17,220
16
3402136
00GR
Southwest Alliance
F
DAB
$
725
$
2,204
$
5,641
$
8,830
$
6,586
$
184
$
24,170
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
248
$
785
$
1,806
$
3,165
$
2,591
$
81
$
8,677
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
632
$
1,743
$
4,485
$
7,297
$
5,924
$
149
$
20,230
$
16,251
$
50,227
$
122,984
$
201,296
$
167,117
$
4,668
$
562,542
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
44,943,022
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SASP-DAB
-
Page 39 of 79
Substance Abuse - Revenue by PIHP by Age Group - State Plan - TANF - Male
M
TANF
October, 2007
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
5,422
$
2,157
$
4,195
$
2,468
$
576
$
-
$
14,819
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
5,237
$
1,686
$
3,555
$
1,862
$
583
$
-
$
12,922
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
2,250
$
932
$
2,043
$
1,196
$
329
$
-
$
6,750
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
6,265
$
1,806
$
2,704
$
1,707
$
538
$
-
$
13,020
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
20,229
$
6,932
$
7,671
$
6,364
$
2,711
$
-
$
43,908
6
1705233
0028
Genesee County CMH Services
M
TANF
$
9,967
$
3,463
$
7,149
$
3,696
$
901
$
-
$
25,176
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
5,277
$
1,601
$
2,731
$
1,472
$
375
$
-
$
11,456
8
1712229
00GV
Lifeways
M
TANF
$
3,492
$
1,122
$
1,987
$
1,108
$
285
$
-
$
7,993
00GX
Macomb County CMH Services
M
TANF
$
8,211
$
2,797
$
4,530
$
3,845
$
1,882
$
-
$
21,265
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
3,338
$
1,229
$
2,126
$
1,264
$
339
$
-
$
8,296
11
4476125
00HF
Northern Affiliation
M
TANF
$
3,395
$
1,304
$
2,467
$
1,552
$
438
$
-
$
9,156
12
4540048
00HC
Northern Lakes
M
TANF
$
3,124
$
1,167
$
2,298
$
1,203
$
355
$
-
$
8,147
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
7,805
$
2,405
$
3,220
$
2,550
$
1,203
$
-
$
17,182
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
3,192
$
1,060
$
1,969
$
1,043
$
312
$
-
$
7,576
15
4390138
00HU
Southeast Partnership
M
TANF
$
5,618
$
1,861
$
3,092
$
1,782
$
551
$
-
$
12,905
16
3402136
00GR
Southwest Alliance
M
TANF
$
5,663
$
1,815
$
3,453
$
1,810
$
466
$
-
$
13,207
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
3,922
$
1,441
$
2,763
$
1,719
$
547
$
-
$
10,393
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
6,060
$
1,914
$
3,771
$
2,177
$
667
$
-
$
14,588
$
108,466
$
36,691
$
61,724
$
38,821
$
13,058
$
-
$
258,760
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SASP-TANF
-
Page 40 of 79
Substance Abuse - Revenue by PIHP by Age Group - State Plan - TANF - Female
F
TANF
October, 2007
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
2,652
$
5,784
$
12,431
$
5,173
$
734
$
-
$
26,774
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
2,650
$
5,279
$
12,708
$
5,026
$
777
$
-
$
26,441
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
1,092
$
2,517
$
5,748
$
2,482
$
337
$
-
$
12,176
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
3,073
$
6,063
$
13,262
$
5,298
$
894
$
-
$
28,591
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
10,033
$
20,760
$
57,102
$
28,375
$
6,138
$
-
$
122,408
6
1705233
0028
Genesee County CMH Services
F
TANF
$
5,097
$
11,693
$
30,307
$
12,034
$
1,862
$
-
$
60,993
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
2,542
$
5,375
$
11,265
$
3,937
$
621
$
-
$
23,741
8
1712229
00GV
Lifeways
F
TANF
$
1,787
$
3,558
$
7,461
$
2,824
$
472
$
-
$
16,102
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
TANF
$
4,071
$
7,831
$
20,570
$
10,650
$
2,179
$
-
$
45,301
10
1724945
00HJ
Northcare
F
TANF
$
1,613
$
3,316
$
7,067
$
3,137
$
455
$
-
$
15,589
11
4476125
00HF
Northern Affiliation
F
TANF
$
1,720
$
3,219
$
7,031
$
3,194
$
461
$
-
$
15,625
12
4540048
00HC
Northern Lakes
F
TANF
$
1,573
$
3,022
$
6,638
$
2,814
$
506
$
-
$
14,553
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
3,839
$
6,806
$
17,695
$
8,992
$
1,864
$
-
$
39,196
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
1,630
$
3,633
$
9,435
$
4,050
$
645
$
-
$
19,393
15
4390138
00HU
Southeast Partnership
F
TANF
$
2,852
$
5,728
$
13,418
$
5,335
$
946
$
-
$
28,278
16
3402136
00GR
Southwest Alliance
F
TANF
$
2,870
$
5,886
$
13,307
$
4,749
$
893
$
-
$
27,705
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
1,993
$
4,033
$
9,555
$
4,096
$
647
$
-
$
20,324
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
3,078
$
6,300
$
13,463
$
5,335
$
939
$
-
$
29,115
$
54,166
$
110,804
$
268,463
$
117,501
$
21,370
$
-
$
572,305
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SASP-TANF
-
Page 41 of 79
Substance Abuse - Revenue by PIHP by Age Group - 1915(b)(3) - DAB - Male
M
DAB
October, 2007
Detail
Revenue for DAB Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
356
$
839
$
1,070
$
2,085
$
2,441
$
128
$
6,919
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
594
$
1,095
$
1,338
$
2,290
$
2,861
$
169
$
8,347
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
280
$
669
$
751
$
1,599
$
1,860
$
93
$
5,254
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
1,194
$
2,226
$
2,442
$
3,872
$
4,837
$
286
$
14,857
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
7,182
$
12,018
$
16,229
$
31,951
$
44,451
$
2,025
$
113,855
6
1705233
0028
Genesee County CMH Services
M
DAB
$
1,434
$
2,364
$
3,024
$
5,915
$
6,508
$
215
$
19,460
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
556
$
1,054
$
1,302
$
2,347
$
2,585
$
130
$
7,974
8
1712229
00GV
Lifeways
M
DAB
$
311
$
487
$
685
$
1,139
$
1,403
$
71
$
4,095
00GX
Macomb County CMH Services
M
DAB
$
1,199
$
2,587
$
2,761
$
5,239
$
6,422
$
566
$
18,775
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
245
$
605
$
799
$
1,697
$
2,090
$
176
$
5,611
11
4476125
00HF
Northern Affiliation
M
DAB
$
306
$
708
$
798
$
1,819
$
2,394
$
151
$
6,176
12
4540048
00HC
Northern Lakes
M
DAB
$
294
$
596
$
669
$
1,548
$
1,951
$
115
$
5,174
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
1,148
$
2,227
$
2,947
$
5,026
$
6,285
$
608
$
18,241
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
704
$
1,086
$
1,478
$
2,854
$
2,967
$
133
$
9,222
15
4390138
00HU
Southeast Partnership
M
DAB
$
523
$
1,105
$
1,347
$
2,208
$
2,567
$
154
$
7,904
16
3402136
00GR
Southwest Alliance
M
DAB
$
811
$
1,383
$
1,705
$
3,177
$
4,057
$
192
$
11,324
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
268
$
540
$
662
$
1,213
$
1,544
$
85
$
4,312
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
703
$
1,144
$
1,400
$
2,732
$
3,360
$
187
$
9,525
$
18,108
$
32,733
$
41,408
$
78,711
$
100,582
$
5,483
$
277,025
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SAB3-DAB
-
Page 42 of 79
Substance Abuse - Revenue by PIHP by Age Group - 1915(b)(3) - DAB - Female
F
DAB
October, 2007
Detail
Revenue for DAB Female Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
122
$
484
$
1,229
$
2,034
$
1,589
$
51
$
5,509
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
209
$
723
$
1,588
$
2,583
$
2,007
$
75
$
7,184
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
102
$
436
$
890
$
1,682
$
1,206
$
35
$
4,351
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
399
$
1,288
$
3,307
$
4,653
$
3,154
$
100
$
12,900
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
2,577
$
7,418
$
17,971
$
30,160
$
27,612
$
726
$
86,465
6
1705233
0028
Genesee County CMH Services
F
DAB
$
509
$
1,441
$
3,959
$
6,622
$
4,394
$
76
$
17,002
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
206
$
710
$
1,725
$
2,743
$
2,025
$
45
$
7,454
8
1712229
00GV
Lifeways
F
DAB
$
115
$
293
$
794
$
1,174
$
944
$
24
$
3,345
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
$
442
$
1,606
$
3,427
$
5,764
$
5,261
$
202
$
16,701
10
1724945
00HJ
Northcare
F
DAB
$
85
$
390
$
903
$
1,624
$
1,391
$
70
$
4,463
11
4476125
00HF
Northern Affiliation
F
DAB
$
107
$
382
$
1,027
$
1,822
$
1,562
$
50
$
4,948
12
4540048
00HC
Northern Lakes
F
DAB
$
95
$
351
$
899
$
1,599
$
1,284
$
39
$
4,267
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
456
$
1,339
$
3,346
$
5,362
$
4,568
$
201
$
15,273
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
234
$
662
$
1,879
$
2,748
$
2,097
$
47
$
7,667
15
4390138
00HU
Southeast Partnership
F
DAB
$
188
$
700
$
1,607
$
2,481
$
1,895
$
59
$
6,930
16
3402136
00GR
Southwest Alliance
F
DAB
$
295
$
887
$
2,266
$
3,546
$
2,647
$
79
$
9,720
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
101
$
314
$
726
$
1,271
$
1,041
$
33
$
3,485
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
246
$
693
$
1,800
$
2,929
$
2,382
$
74
$
8,124
$
6,486
$
20,118
$
49,341
$
80,796
$
67,060
$
1,985
$
225,787
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SAB3-DAB
-
Page 43 of 79
Substance Abuse - Revenue by PIHP by Age Group - 1915(b)(3) - TANF - Male
M
TANF
October, 2007
Detail
Revenue for TANF Male by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
TANF
$
2,440
$
967
$
1,885
$
1,109
$
259
$
-
$
6,659
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
TANF
$
2,304
$
760
$
1,594
$
837
$
262
$
-
$
5,757
3
4344340
00GG
CMH for Central Michigan
M
TANF
$
1,031
$
421
$
921
$
539
$
148
$
-
$
3,060
4
4483587
00GS
CMHSA Network of West Michigan
M
TANF
$
2,909
$
813
$
1,218
$
770
$
242
$
-
$
5,952
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
TANF
$
9,103
$
3,120
$
3,452
$
2,874
$
1,222
$
-
$
19,771
6
1705233
0028
Genesee County CMH Services
M
TANF
$
4,475
$
1,561
$
3,218
$
1,662
$
405
$
-
$
11,322
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
TANF
$
2,345
$
718
$
1,230
$
661
$
168
$
-
$
5,122
8
1712229
00GV
Lifeways
M
TANF
$
1,552
$
505
$
895
$
497
$
128
$
-
$
3,577
00GX
Macomb County CMH Services
M
TANF
$
3,790
$
1,261
$
2,039
$
1,729
$
845
$
-
$
9,665
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
TANF
$
1,517
$
549
$
954
$
569
$
153
$
-
$
3,742
11
4476125
00HF
Northern Affiliation
M
TANF
$
1,533
$
587
$
1,109
$
697
$
197
$
-
$
4,123
12
4540048
00HC
Northern Lakes
M
TANF
$
1,411
$
524
$
1,029
$
541
$
159
$
-
$
3,664
13
1705289
0058
Oakland County CMH Authority
M
TANF
$
3,469
$
1,081
$
1,449
$
1,147
$
540
$
-
$
7,685
14
1712541
00HQ
Saginaw County CMH Authority
M
TANF
$
1,419
$
474
$
884
$
469
$
140
$
-
$
3,387
15
4390138
00HU
Southeast Partnership
M
TANF
$
2,568
$
838
$
1,390
$
802
$
248
$
-
$
5,847
16
3402136
00GR
Southwest Alliance
M
TANF
$
2,589
$
818
$
1,554
$
814
$
210
$
-
$
5,985
17
1708164
00HO
Thumb Mental Health Alliance
M
TANF
$
1,755
$
649
$
1,242
$
772
$
246
$
-
$
4,663
18
2920843
00HR
Venture Behavioral Health
M
TANF
$
2,737
$
865
$
1,694
$
979
$
300
$
-
$
6,575
$
48,946
$
16,511
$
27,757
$
17,468
$
5,873
$
-
$
116,555
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SAB3-TANF
-
Page 44 of 79
Substance Abuse - Revenue by PIHP by Age Group - 1915(b)(3) - TANF - Female
F
TANF
October, 2007
Detail
Revenue for TANF Female by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
TANF
$
1,193
$
2,611
$
5,569
$
2,324
$
330
$
-
$
12,028
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
TANF
$
1,223
$
2,378
$
5,709
$
2,266
$
349
$
-
$
11,924
3
4344340
00GG
CMH for Central Michigan
F
TANF
$
455
$
1,125
$
2,576
$
1,115
$
152
$
-
$
5,422
4
4483587
00GS
CMHSA Network of West Michigan
F
TANF
$
1,317
$
2,741
$
5,935
$
2,381
$
402
$
-
$
12,776
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
TANF
$
5,017
$
9,362
$
25,568
$
12,720
$
2,754
$
-
$
55,421
6
1705233
0028
Genesee County CMH Services
F
TANF
$
2,243
$
5,243
$
13,620
$
5,411
$
837
$
-
$
27,354
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
TANF
$
1,130
$
2,408
$
5,052
$
1,772
$
280
$
-
$
10,642
8
1712229
00GV
Lifeways
F
TANF
$
777
$
1,593
$
3,349
$
1,268
$
212
$
-
$
7,199
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
TANF
$
1,832
$
3,506
$
9,264
$
4,788
$
979
$
-
$
20,370
10
1724945
00HJ
Northcare
F
TANF
$
664
$
1,481
$
3,179
$
1,412
$
204
$
-
$
6,940
11
4476125
00HF
Northern Affiliation
F
TANF
$
752
$
1,451
$
3,150
$
1,435
$
207
$
-
$
6,995
12
4540048
00HC
Northern Lakes
F
TANF
$
688
$
1,360
$
2,981
$
1,266
$
228
$
-
$
6,522
13
1705289
0058
Oakland County CMH Authority
F
TANF
$
1,706
$
3,074
$
7,951
$
4,038
$
839
$
-
$
17,607
14
1712541
00HQ
Saginaw County CMH Authority
F
TANF
$
724
$
1,632
$
4,228
$
1,819
$
289
$
-
$
8,693
15
4390138
00HU
Southeast Partnership
F
TANF
$
1,268
$
2,577
$
6,044
$
2,397
$
425
$
-
$
12,710
16
3402136
00GR
Southwest Alliance
F
TANF
$
1,276
$
2,652
$
5,981
$
2,131
$
401
$
-
$
12,440
17
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
897
$
1,813
$
4,296
$
1,838
$
291
$
-
$
9,135
18
2920843
00HR
Venture Behavioral Health
F
TANF
$
1,347
$
2,817
$
6,069
$
2,401
$
422
$
-
$
13,056
$
24,509
$
49,826
$
120,520
$
52,781
$
9,599
$
-
$
257,235
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
SAB3-TANF
0
Page 45 of 79
Habilitation Supports Waiver - Capitation by PIHP
October, 2007
Summary by Population Group by Gender
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
DAB Capitation
Total Capitation
TANF Capitation
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
217
143
-
-
360
$
941,074
$
615,633
$
-
$
-
$
1,556,707
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
214
136
-
-
350
$
991,606
$
642,873
$
-
$
-
$
1,634,479
3
4344340
00GG
CMH for Central Michigan
302
212
2
-
516
$
1,080,777
$
742,254
$
3,973
$
-
$
1,827,005
4
4483587
00GS
CMHSA Network of West Michigan
101
59
-
-
160
$
362,697
$
217,417
$
-
$
-
$
580,114
5
3119549
00GJ
Detroit Wayne County CMH Agency
626
505
-
-
1,131
$
3,054,659
$
2,461,637
$
-
$
-
$
5,516,296
6
1705233
0028
Genesee County CMH Services
206
146
1
-
353
$
735,727
$
536,759
$
1,914
$
-
$
1,274,400
7
1712452
00HA
Lakeshore Behavioral Health Alliance
121
104
-
-
225
$
546,591
$
472,944
$
-
$
-
$
1,019,535
8
1712229
00GV
Lifeways
161
97
-
-
258
$
362,251
$
214,948
$
-
$
-
$
577,199
9
3396315
00GX
Macomb County CMH Services
230
178
2
-
410
$
827,443
$
622,574
$
6,432
$
-
$
1,456,449
10
1724945
00HJ
Northcare
225
129
2
-
356
$
1,120,956
$
637,721
$
5,376
$
-
$
1,764,053
11
4476125
00HF
Northern Affiliation
247
162
-
-
409
$
1,291,833
$
807,983
$
-
$
-
$
2,099,816
12
4540048
00HC
Northern Lakes
95
73
-
-
168
$
414,371
$
330,313
$
-
$
-
$
744,685
13
1705289
0058
Oakland County CMH Authority
432
336
-
1
769
$
2,127,523
$
1,650,111
$
-
$
2,607
$
3,780,242
14
1712541
00HQ
Saginaw County CMH Authority
62
40
-
-
102
$
327,723
$
215,930
$
-
$
-
$
543,652
15
4390138
00HU
Southeast Partnership
372
274
1
1
648
$
1,460,484
$
1,049,770
$
2,833
$
2,720
$
2,515,808
16
3402136
00GR
Southwest Alliance
253
191
-
-
444
$
921,118
$
686,606
$
-
$
-
$
1,607,725
17
1708164
00HO
Thumb Mental Health Alliance
166
97
-
1
264
$
859,962
$
512,342
$
-
$
2,758
$
1,375,062
18
2920843
00HR
Venture Behavioral Health
171
128
1
-
300
$
744,504
$
544,070
$
4,273
$
-
$
1,292,847
Male
Female
Male
Total
Enrollees
Female
Male
Female
Male
Female
19
-
$
-
20
-
$
-
State Subtotals
4,201
3,010
7,211
9
3
7,223
12
-
$
18,171,301
$
12,961,885
31,133,186
$
24,801
$
8,086
$
31,166,072
32,887
$
31,166,072
(1.00)
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by PIHP
Page 46 of 79
Habilitation Supports Waiver - Capitation by County
October, 2007
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
TANF Capitation
DAB Capitation
Total
Enrollees
Total Capitation
County Name - COFR Code R
County Name Residence
25
GENESEE
25
GENESEE
205
1
-
351
$
$
532,508
$
1,914
$
-
$
1,266,749
25
GENESEE
37
ISABELLA
-
1
-
-
1
$
-
$
4,252
$
-
$
-
$
4,252
0028
25
GENESEE
56
MIDLAND
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
1705289
0058
63
OAKLAND
25
GENESEE
-
1
-
-
1
$
-
$
4,551
$
-
$
-
$
4,551
5
1705289
0058
63
OAKLAND
50
MACOMB
6
3
-
-
9
$
19,868
$
10,374
$
-
$
-
$
30,242
6
1705289
0058
63
OAKLAND
57
MISSAUKEE
1
-
-
-
1
$
3,406
$
-
$
-
$
-
$
3,406
7
1705289
0058
63
OAKLAND
63
OAKLAND
331
-
1
757
$
2,104,249
$
1,630,630
$
-
$
2,607
$
3,737,486
8
1705289
0058
63
OAKLAND
82
WAYNE
-
1
-
-
1
$
-
$
4,557
$
-
$
-
$
4,557
9
1708001
00BJ
10
BENZIE
10
BENZIE
13
4
-
-
17
$
68,396
$
20,499
$
-
$
-
$
88,895
10
1708001
00BJ
10
BENZIE
51
MANISTEE
3
4
-
-
7
$
15,952
$
19,368
$
-
$
-
$
35,320
11
1708001
00BJ
10
BENZIE
83
WEXFORD
1
-
-
-
1
$
4,928
$
-
$
-
$
-
$
4,928
12
1708001
00BJ
19
CLINTON
19
CLINTON
21
11
-
-
32
$
90,079
$
50,124
$
-
$
-
$
140,203
13
1708001
00BJ
19
CLINTON
33
INGHAM
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
14
1708001
00BJ
23
EATON
19
CLINTON
3
1
-
-
4
$
13,670
$
4,557
$
-
$
-
$
18,227
15
1708001
00BJ
23
EATON
23
EATON
37
16
-
-
53
$
169,719
$
68,446
$
-
$
-
$
238,166
16
1708001
00BJ
23
EATON
33
INGHAM
3
2
-
-
5
$
13,660
$
7,963
$
-
$
-
$
21,623
17
1708001
00BJ
29
GRATIOT
18
CLARE
-
1
-
-
1
$
-
$
3,400
$
-
$
-
$
3,400
18
1708001
00BJ
29
GRATIOT
28
GRAND TRAVERSE
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
19
1708001
00BJ
29
GRATIOT
29
GRATIOT
19
9
-
-
28
$
92,430
$
41,060
$
-
$
-
$
133,490
20
1708001
00BJ
33
INGHAM
19
CLINTON
3
1
-
-
4
$
13,670
$
4,557
$
-
$
-
$
18,227
21
1708001
00BJ
33
INGHAM
23
EATON
3
1
-
-
4
$
12,520
$
4,557
$
-
$
-
$
17,076
22
1708001
00BJ
33
INGHAM
29
GRATIOT
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
23
1708001
00BJ
33
INGHAM
33
INGHAM
49
35
-
-
84
$
226,590
$
165,760
$
-
$
-
$
392,350
24
1708001
00BJ
34
IONIA
11
BERRIEN
-
1
-
-
1
$
-
$
4,153
$
-
$
-
$
4,153
25
1708001
00BJ
34
IONIA
34
IONIA
17
12
-
-
29
$
79,740
$
62,646
$
-
$
-
$
142,386
26
1708001
00BJ
34
IONIA
37
ISABELLA
1
-
-
-
1
$
4,252
$
-
$
-
$
-
$
4,252
27
1708001
00BJ
34
IONIA
59
MONTCALM
3
1
-
-
4
$
14,053
$
4,153
$
-
$
-
$
18,206
28
1708001
00BJ
51
MANISTEE
10
BENZIE
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
29
1708001
00BJ
51
MANISTEE
37
ISABELLA
1
-
-
-
1
$
2,542
$
-
$
-
$
-
$
2,542
30
1708001
00BJ
51
MANISTEE
51
MANISTEE
25
26
-
-
51
$
116,141
$
131,136
$
-
$
-
$
247,277
31
1708001
00BJ
62
NEWAYGO
62
NEWAYGO
9
10
-
-
19
$
39,594
$
45,567
$
-
$
-
$
85,161
32
1705322
00GE
06
ARENAC
06
ARENAC
11
14
-
-
25
$
45,679
$
57,089
$
-
$
-
$
102,768
33
1705322
00GE
06
ARENAC
09
BAY
1
1
-
-
2
$
5,192
$
4,153
$
-
$
-
$
9,345
34
1705322
00GE
09
BAY
06
ARENAC
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
35
1705322
00GE
09
BAY
09
BAY
84
66
-
-
150
$
368,121
$
$
-
$
-
$
661,100
Provider ID
Billing
Agent
Code F
1
1705233
0028
2
1705233
0028
3
1705233
4
Report Generated: 10/15/2007
12:47 PM
Male
Female
425
145
Male
Female
Male
Female
732,327
Male
292,979
Female
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 47 of 79
Habilitation Supports Waiver - Capitation by County
October, 2007
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
County Name Residence
Revenue - Habilitation Supports Waiver
TANF Enrollees
TANF Capitation
DAB Capitation
Total
Enrollees
Total Capitation
Provider ID
Billing
Agent
Code F
36
1705322
00GE
09
BAY
79
TUSCOLA
1
-
-
-
1
$
5,748
$
-
$
-
$
-
$
5,748
37
1705322
00GE
32
HURON
32
HURON
35
16
-
-
51
$
144,218
$
60,116
$
-
$
-
$
204,333
38
1705322
00GE
59
MONTCALM
33
INGHAM
-
1
-
-
1
$
-
$
6,307
$
-
$
-
$
6,307
39
1705322
00GE
59
MONTCALM
34
IONIA
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
40
1705322
00GE
59
MONTCALM
41
KENT
1
3
-
-
4
$
3,639
$
11,215
$
-
$
-
$
14,854
41
1705322
00GE
59
MONTCALM
59
MONTCALM
18
5
-
-
23
$
76,103
$
21,102
$
-
$
-
$
97,205
42
1705322
00GE
78
SHIAWASSEE
33
INGHAM
-
1
-
-
1
$
-
$
5,698
$
-
$
-
$
5,698
43
1705322
00GE
78
SHIAWASSEE
78
SHIAWASSEE
29
15
-
-
44
$
138,725
$
70,042
$
-
$
-
$
208,767
44
1705322
00GE
79
TUSCOLA
79
TUSCOLA
36
20
-
-
56
$
149,495
$
82,004
$
-
$
-
$
231,500
45
4344340
00GG
18
CLARE
18
CLARE
41
35
-
-
76
$
139,379
$
118,373
$
-
$
-
$
257,752
46
4344340
00GG
18
CLARE
67
OSCEOLA
1
1
-
-
2
$
2,542
$
3,400
$
-
$
-
$
5,942
47
4344340
00GG
26
GLADWIN
18
CLARE
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
48
4344340
00GG
26
GLADWIN
26
GLADWIN
21
10
-
-
31
$
75,634
$
36,819
$
-
$
-
$
112,453
49
4344340
00GG
26
GLADWIN
40
KALKASKA
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
50
4344340
00GG
37
ISABELLA
18
CLARE
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
51
4344340
00GG
37
ISABELLA
37
ISABELLA
89
81
1
-
171
$
326,168
$
$
1,788
$
-
$
619,677
52
4344340
00GG
37
ISABELLA
54
MECOSTA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
53
4344340
00GG
37
ISABELLA
56
MIDLAND
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
54
4344340
00GG
54
MECOSTA
26
GLADWIN
1
-
-
-
1
$
3,678
$
-
$
-
$
-
$
3,678
55
4344340
00GG
54
MECOSTA
54
MECOSTA
35
25
-
-
60
$
117,892
$
79,542
$
-
$
-
$
197,434
56
4344340
00GG
54
MECOSTA
59
MONTCALM
-
-
1
-
1
$
-
$
-
$
2,184
$
-
$
2,184
57
4344340
00GG
54
MECOSTA
67
OSCEOLA
-
1
-
-
1
$
-
$
3,678
$
-
$
-
$
3,678
58
4344340
00GG
56
MIDLAND
26
GLADWIN
-
1
-
-
1
$
-
$
2,542
$
-
$
-
$
2,542
59
4344340
00GG
56
MIDLAND
37
ISABELLA
-
1
-
-
1
$
-
$
4,252
$
-
$
-
$
4,252
60
4344340
00GG
56
MIDLAND
54
MECOSTA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
61
4344340
00GG
56
MIDLAND
56
MIDLAND
83
42
-
-
125
$
303,372
$
$
-
$
-
$
457,148
62
4344340
00GG
56
MIDLAND
80
VAN BUREN
1
-
-
-
1
$
3,104
$
-
$
-
$
-
$
3,104
63
4344340
00GG
67
OSCEOLA
43
LAKE
1
-
-
-
1
$
6,307
$
-
$
-
$
-
$
6,307
64
4344340
00GG
67
OSCEOLA
54
MECOSTA
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
65
4344340
00GG
67
OSCEOLA
67
OSCEOLA
21
13
-
-
34
$
74,742
$
39,044
$
-
$
-
$
113,786
66
4344340
00GG
67
OSCEOLA
80
VAN BUREN
1
1
-
-
2
$
4,153
$
4,153
$
-
$
-
$
8,305
67
4344340
00GG
67
OSCEOLA
83
WEXFORD
1
-
-
-
1
$
3,406
$
-
$
-
$
-
$
3,406
68
3119549
00GJ
82
WAYNE
24
EMMET
1
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
69
3119549
00GJ
82
WAYNE
28
GRAND TRAVERSE
1
-
-
-
1
$
3,406
$
-
$
-
$
-
$
3,406
70
3119549
00GJ
82
WAYNE
33
INGHAM
2
-
-
-
2
$
9,485
$
-
$
-
$
-
$
9,485
County Name - COFR Code R
Report Generated: 10/15/2007
12:47 PM
Male
Female
Male
Female
Male
Female
Male
291,720
153,776
Female
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 48 of 79
Habilitation Supports Waiver - Capitation by County
October, 2007
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
TANF Capitation
DAB Capitation
Total
Enrollees
Total Capitation
County Name - COFR Code R
County Name Residence
82
WAYNE
37
ISABELLA
1
-
-
-
1
$
4,707
$
-
$
-
$
-
$
4,707
82
WAYNE
50
MACOMB
-
1
-
-
1
$
-
$
2,476
$
-
$
-
$
2,476
00GJ
82
WAYNE
56
MIDLAND
-
1
-
-
1
$
-
$
4,707
$
-
$
-
$
4,707
00GJ
82
WAYNE
63
OAKLAND
2
1
-
-
3
$
13,059
$
3,705
$
-
$
-
$
16,764
3119549
00GJ
82
WAYNE
75
ST JOSEPH
-
3119549
00GJ
82
WAYNE
82
WAYNE
77
3402136
00GR
03
ALLEGAN
03
78
3402136
00GR
03
ALLEGAN
39
79
3402136
00GR
03
ALLEGAN
80
3402136
00GR
03
81
3402136
00GR
82
3402136
00GR
83
3402136
84
Provider ID
Billing
Agent
Code F
71
3119549
00GJ
72
3119549
00GJ
73
3119549
74
3119549
75
76
Male
Female
1
Male
Female
Male
Female
Male
Female
-
-
-
1
$
3,400
$
$
-
$
-
$
3,400
618
502
-
-
1,120
$
3,015,646
$
2,450,749
$
-
$
-
$
5,466,394
ALLEGAN
55
54
-
-
109
$
194,214
$
187,593
$
-
$
-
$
381,808
KALAMAZOO
-
1
-
-
1
$
-
$
2,542
$
-
$
-
$
2,542
70
OTTAWA
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
ALLEGAN
80
VAN BUREN
2
-
-
-
2
$
10,385
$
-
$
-
$
-
$
10,385
14
CASS
14
CASS
9
8
-
-
17
$
28,885
$
25,484
$
-
$
-
$
54,369
14
CASS
39
KALAMAZOO
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
00GR
39
KALAMAZOO
03
ALLEGAN
1
-
-
-
1
$
3,678
$
-
$
-
$
-
$
3,678
3402136
00GR
39
KALAMAZOO
12
BRANCH
-
1
-
-
1
$
-
$
5,748
$
-
$
-
$
5,748
85
3402136
00GR
39
KALAMAZOO
18
CLARE
-
1
-
-
1
$
-
$
2,924
$
-
$
-
$
2,924
86
3402136
00GR
39
KALAMAZOO
34
IONIA
-
1
-
-
1
$
-
$
6,307
$
-
$
-
$
6,307
87
3402136
00GR
39
KALAMAZOO
39
KALAMAZOO
104
-
-
260
$
580,809
$
384,145
$
-
$
-
$
964,954
88
3402136
00GR
39
KALAMAZOO
80
VAN BUREN
1
-
-
-
1
$
4,491
$
-
$
-
$
-
$
4,491
89
3402136
00GR
75
ST JOSEPH
03
ALLEGAN
1
-
-
-
1
$
3,400
$
-
$
-
$
-
$
3,400
90
3402136
00GR
75
ST JOSEPH
12
BRANCH
91
3402136
00GR
75
ST JOSEPH
75
ST JOSEPH
92
3402136
00GR
75
ST JOSEPH
80
VAN BUREN
93
4483587
00GS
41
KENT
41
KENT
94
1712229
00GV
30
HILLSDALE
30
HILLSDALE
95
1712229
00GV
30
HILLSDALE
38
JACKSON
96
1712229
00GV
38
JACKSON
30
97
1712229
00GV
38
JACKSON
98
1712229
00GV
38
99
1712229
00GV
38
100
3396315
00GX
101
3396315
00GX
102
3396315
00GX
50
MACOMB
63
OAKLAND
30
20
-
103
1712452
00HA
61
MUSKEGON
61
MUSKEGON
77
59
-
104
1712452
00HA
70
OTTAWA
39
KALAMAZOO
-
1
-
105
1712452
00HA
70
OTTAWA
70
OTTAWA
43
44
-
156
1
2
-
-
3
$
4,153
$
8,305
$
-
$
-
$
12,458
25
18
-
-
43
$
83,551
$
58,628
$
-
$
-
$
142,178
-
-
-
-
1
$
4,153
$
$
-
$
-
$
4,153
101
59
-
-
160
$
362,697
$
217,417
$
-
$
-
$
580,114
42
22
-
-
64
$
96,424
$
51,279
$
-
$
-
$
147,703
2
2
-
-
4
$
3,972
$
4,546
$
-
$
-
$
8,517
HILLSDALE
2
2
-
-
4
$
5,115
$
4,731
$
-
$
-
$
9,845
33
INGHAM
1
-
-
-
1
$
3,406
$
-
$
-
$
-
$
3,406
JACKSON
38
JACKSON
113
71
-
-
184
$
249,192
$
$
-
$
-
$
403,585
JACKSON
50
MACOMB
1
-
-
-
1
$
4,142
$
-
$
-
$
-
$
4,142
50
MACOMB
37
ISABELLA
-
1
-
-
1
$
-
$
3,678
$
-
$
-
$
3,678
50
MACOMB
50
MACOMB
200
2
-
359
$
666,099
$
524,366
$
6,432
$
-
$
1,196,897
-
50
$
161,345
$
94,530
$
-
$
-
$
255,875
-
136
$
348,494
$
267,695
$
-
$
-
$
616,189
-
1
$
$
3,678
$
-
$
-
$
3,678
-
87
$
$
201,571
$
-
$
-
$
395,516
Report Generated: 10/15/2007
12:47 PM
1
157
193,944
154,393
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 49 of 79
Habilitation Supports Waiver - Capitation by County
October, 2007
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
Provider ID
Billing
Agent
Code F
County Name - COFR Code R
County Name Residence
Male
Revenue - Habilitation Supports Waiver
TANF Enrollees
Female
Male
Female
TANF Capitation
DAB Capitation
Total
Enrollees
Male
Female
Male
Total Capitation
Female
106
1712452
00HA
70
OTTAWA
80
VAN BUREN
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
107
4540048
00HC
20
CRAWFORD
20
CRAWFORD
2
7
-
-
9
$
7,963
$
34,248
$
-
$
-
$
42,211
108
4540048
00HC
20
CRAWFORD
72
ROSCOMMON
1
1
-
-
2
$
3,406
$
3,406
$
-
$
-
$
6,812
109
4540048
00HC
28
GRAND TRAVERSE
03
ALLEGAN
1
-
-
-
1
$
3,678
$
-
$
-
$
-
$
3,678
110
4540048
00HC
28
GRAND TRAVERSE
28
GRAND TRAVERSE
22
24
-
-
46
$
101,713
$
$
-
$
-
$
211,265
111
4540048
00HC
28
GRAND TRAVERSE
67
OSCEOLA
2
-
-
-
2
$
7,078
$
-
$
-
$
-
$
7,078
112
4540048
00HC
43
LAKE
43
LAKE
4
1
-
-
5
$
14,916
$
4,557
$
-
$
-
$
19,473
113
4540048
00HC
43
LAKE
64
OCEANA
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
114
4540048
00HC
45
LEELANAU
28
GRAND TRAVERSE
1
2
-
-
3
$
3,406
$
7,963
$
-
$
-
$
11,369
115
4540048
00HC
45
LEELANAU
45
LEELANAU
6
3
-
-
9
$
27,340
$
13,670
$
-
$
-
$
41,010
116
4540048
00HC
53
MASON
53
MASON
9
1
-
-
10
$
37,283
$
4,557
$
-
$
-
$
41,840
117
4540048
00HC
57
MISSAUKEE
57
MISSAUKEE
1
1
-
-
2
$
4,557
$
3,406
$
-
$
-
$
7,963
118
4540048
00HC
64
OCEANA
28
GRAND TRAVERSE
-
1
-
-
1
$
-
$
4,557
$
-
$
-
$
4,557
119
4540048
00HC
64
OCEANA
64
OCEANA
11
5
-
-
16
$
50,495
$
22,784
$
-
$
-
$
73,279
120
4540048
00HC
72
ROSCOMMON
30
HILLSDALE
1
-
-
-
1
$
2,458
$
-
$
-
$
-
$
2,458
121
4540048
00HC
72
ROSCOMMON
72
ROSCOMMON
6
14
-
-
20
$
30,232
$
64,166
$
-
$
-
$
94,397
122
4540048
00HC
72
ROSCOMMON
83
WEXFORD
1
1
-
-
2
$
3,406
$
4,557
$
-
$
-
$
7,963
123
4540048
00HC
83
WEXFORD
57
MISSAUKEE
8
4
-
-
12
$
36,454
$
18,227
$
-
$
-
$
54,680
124
4540048
00HC
83
WEXFORD
67
OSCEOLA
4
-
-
-
4
$
13,601
$
-
$
-
$
-
$
13,601
125
4540048
00HC
83
WEXFORD
72
ROSCOMMON
-
2
-
-
2
$
-
$
9,485
$
-
$
-
$
9,485
126
4540048
00HC
83
WEXFORD
83
WEXFORD
14
6
-
-
20
$
61,829
$
25,180
$
-
$
-
$
87,009
127
4476125
00HF
01
ALCONA
01
ALCONA
14
7
-
-
21
$
70,698
$
30,942
$
-
$
-
$
101,640
128
4476125
00HF
01
ALCONA
04
ALPENA
1
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
129
4476125
00HF
04
ALPENA
01
ALCONA
2
-
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
130
4476125
00HF
04
ALPENA
04
ALPENA
46
19
-
-
65
$
242,096
$
90,410
$
-
$
-
$
332,506
131
4476125
00HF
04
ALPENA
09
BAY
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
132
4476125
00HF
04
ALPENA
25
GENESEE
-
1
-
-
1
$
-
$
3,639
$
-
$
-
$
3,639
133
4476125
00HF
04
ALPENA
60
MONTMORENCY
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
134
4476125
00HF
04
ALPENA
71
PRESQUE ISLE
2
-
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
135
4476125
00HF
05
ANTRIM
05
ANTRIM
20
8
-
-
28
$
114,282
$
41,962
$
-
$
-
$
156,243
136
4476125
00HF
05
ANTRIM
28
GRAND TRAVERSE
-
1
-
-
1
$
-
$
4,928
$
-
$
-
$
4,928
137
4476125
00HF
15
CHARLEVOIX
05
ANTRIM
1
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
138
4476125
00HF
15
CHARLEVOIX
15
CHARLEVOIX
22
11
-
-
33
$
115,529
$
57,236
$
-
$
-
$
172,765
139
4476125
00HF
15
CHARLEVOIX
16
CHEBOYGAN
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
140
4476125
00HF
15
CHARLEVOIX
24
EMMET
3
3
-
-
6
$
19,920
$
14,023
$
-
$
-
$
33,942
Report Generated: 10/15/2007
12:47 PM
109,552
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 50 of 79
Habilitation Supports Waiver - Capitation by County
October, 2007
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
County Name - COFR Code R
County Name Residence
15
CHARLEVOIX
40
KALKASKA
15
CHARLEVOIX
69
OTSEGO
00HF
16
CHEBOYGAN
15
CHARLEVOIX
1
-
-
00HF
16
CHEBOYGAN
16
CHEBOYGAN
9
11
-
4476125
00HF
16
CHEBOYGAN
49
MACKINAC
1
-
-
4476125
00HF
16
CHEBOYGAN
60
MONTMORENCY
1
-
-
147
4476125
00HF
16
CHEBOYGAN
69
OTSEGO
2
1
-
-
148
4476125
00HF
24
EMMET
24
EMMET
-
1
-
149
4476125
00HF
35
IOSCO
35
IOSCO
15
9
-
150
4476125
00HF
35
IOSCO
73
SAGINAW
-
-
-
151
4476125
00HF
40
KALKASKA
05
ANTRIM
152
4476125
00HF
40
KALKASKA
40
KALKASKA
153
4476125
00HF
60
MONTMORENCY
04
ALPENA
1
1
-
154
4476125
00HF
60
MONTMORENCY
60
MONTMORENCY
15
20
-
155
4476125
00HF
60
MONTMORENCY
71
PRESQUE ISLE
-
1
-
156
4476125
00HF
65
OGEMAW
18
CLARE
1
-
-
157
4476125
00HF
65
OGEMAW
35
IOSCO
1
-
158
4476125
00HF
65
OGEMAW
65
OGEMAW
7
159
4476125
00HF
65
OGEMAW
68
OSCODA
1
160
4476125
00HF
68
OSCODA
35
IOSCO
1
-
-
161
4476125
00HF
68
OSCODA
65
OGEMAW
2
-
-
162
4476125
00HF
68
OSCODA
68
OSCODA
2
-
-
163
4476125
00HF
69
OTSEGO
16
CHEBOYGAN
-
1
164
4476125
00HF
69
OTSEGO
24
EMMET
1
165
4476125
00HF
69
OTSEGO
28
GRAND TRAVERSE
166
4476125
00HF
69
OTSEGO
40
KALKASKA
167
4476125
00HF
69
OTSEGO
69
168
4476125
00HF
71
PRESQUE ISLE
169
4476125
00HF
71
PRESQUE ISLE
170
4476125
00HF
71
171
4476125
00HF
172
4476125
00HF
173
4476125
00HF
174
1724945
00HJ
175
1724945
00HJ
07
Provider ID
Billing
Agent
Code F
141
4476125
00HF
142
4476125
00HF
143
4476125
144
4476125
145
146
Male
Total
Enrollees
Male
Female
Male
Total Capitation
Female
Female
Male
-
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
2
3
-
-
5
$
10,318
$
15,274
$
-
$
-
$
25,592
-
1
$
3,705
$
-
$
-
$
-
$
3,705
-
20
$
40,855
$
49,516
$
-
$
-
$
90,371
-
1
$
3,820
$
-
$
-
$
-
$
3,820
-
1
$
4,957
$
-
$
-
$
-
$
4,957
3
$
11,818
$
4,957
$
-
$
-
$
16,774
-
1
$
-
$
4,957
$
-
$
-
$
4,957
-
24
$
82,199
$
50,814
$
-
$
-
$
133,014
1
$
5,244
$
-
$
-
$
-
$
5,244
1
Female
TANF Capitation
DAB Capitation
1
-
-
-
1
$
3,705
$
-
$
-
$
-
$
3,705
14
13
-
-
27
$
67,447
$
57,080
$
-
$
-
$
124,527
-
2
$
4,957
$
4,957
$
-
$
-
$
9,913
-
35
$
79,215
$
101,689
$
-
$
-
$
180,904
-
1
$
-
$
6,198
$
-
$
-
$
6,198
-
1
$
2,542
$
-
$
-
$
-
$
2,542
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
13
-
-
20
$
39,660
$
74,353
$
-
$
-
$
114,014
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
-
1
$
4,957
$
-
$
-
$
-
$
4,957
-
2
$
9,913
$
-
$
-
$
-
$
9,913
-
2
$
9,913
$
-
$
-
$
-
$
9,913
-
-
1
$
-
$
3,705
$
-
$
-
$
3,705
-
-
-
1
$
3,705
$
-
$
-
$
-
$
3,705
-
1
-
-
1
$
-
$
4,557
$
-
$
-
$
4,557
1
1
-
-
2
$
4,957
$
4,957
$
-
$
-
$
9,913
OTSEGO
30
20
-
-
50
$
167,849
$
105,055
$
-
$
-
$
272,905
04
ALPENA
2
-
-
-
2
$
9,913
$
-
$
-
$
-
$
9,913
34
IONIA
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
PRESQUE ISLE
37
ISABELLA
-
1
-
-
1
$
-
$
3,678
$
-
$
-
$
3,678
71
PRESQUE ISLE
63
OAKLAND
1
-
-
-
1
$
4,957
$
-
$
-
$
-
$
4,957
71
PRESQUE ISLE
71
PRESQUE ISLE
20
12
-
-
32
$
100,189
$
58,228
$
-
$
-
$
158,417
71
PRESQUE ISLE
79
TUSCOLA
1
-
-
-
1
$
4,153
$
-
$
-
$
-
$
4,153
02
ALGER
02
ALGER
3
5
-
-
8
$
15,321
$
24,263
$
-
$
-
$
39,584
BARAGA
07
BARAGA
4
2
-
-
6
$
20,443
$
10,221
$
-
$
-
$
30,664
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 51 of 79
Habilitation Supports Waiver - Capitation by County
October, 2007
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
Revenue - Habilitation Supports Waiver
TANF Enrollees
TANF Capitation
DAB Capitation
Total
Enrollees
Total Capitation
County Name - COFR Code R
County Name Residence
17
CHIPPEWA
17
CHIPPEWA
21
12
-
-
33
$
$
55,757
$
-
$
-
$
158,861
17
CHIPPEWA
28
GRAND TRAVERSE
-
1
-
-
1
$
-
$
4,557
$
-
$
-
$
4,557
00HJ
17
CHIPPEWA
56
MIDLAND
1
-
-
-
1
$
4,252
$
-
$
-
$
-
$
4,252
00HJ
17
CHIPPEWA
77
SCHOOLCRAFT
1
-
-
-
1
$
5,528
$
-
$
-
$
-
$
5,528
1724945
00HJ
21
DELTA
21
DELTA
37
19
1
-
57
$
188,434
$
100,931
$
2,688
$
-
$
292,053
182
1724945
00HJ
21
DELTA
55
MENOMINEE
183
1724945
00HJ
22
DICKINSON
22
DICKINSON
184
1724945
00HJ
22
DICKINSON
55
MENOMINEE
185
1724945
00HJ
27
GOGEBIC
27
GOGEBIC
186
1724945
00HJ
27
GOGEBIC
55
MENOMINEE
187
1724945
00HJ
31
HOUGHTON
07
BARAGA
2
2
-
188
1724945
00HJ
31
HOUGHTON
31
HOUGHTON
43
20
-
189
1724945
00HJ
36
IRON
36
IRON
11
4
-
190
1724945
00HJ
48
LUCE
48
LUCE
4
8
-
191
1724945
00HJ
49
MACKINAC
49
MACKINAC
7
3
-
192
1724945
00HJ
52
MARQUETTE
21
DELTA
1
1
193
1724945
00HJ
52
MARQUETTE
52
MARQUETTE
37
18
194
1724945
00HJ
52
MARQUETTE
55
MENOMINEE
1
-
-
195
1724945
00HJ
55
MENOMINEE
22
DICKINSON
1
-
-
196
1724945
00HJ
55
MENOMINEE
55
MENOMINEE
11
8
1
197
1724945
00HJ
77
SCHOOLCRAFT
13
CALHOUN
-
1
-
198
1724945
00HJ
77
SCHOOLCRAFT
48
LUCE
-
1
199
1724945
00HJ
77
SCHOOLCRAFT
77
SCHOOLCRAFT
4
200
1708164
00HO
44
LAPEER
44
LAPEER
201
1708164
00HO
44
LAPEER
76
SANILAC
202
1708164
00HO
74
ST CLAIR
30
203
1708164
00HO
74
ST CLAIR
41
204
1708164
00HO
74
ST CLAIR
74
ST CLAIR
84
54
-
1
205
1708164
00HO
76
SANILAC
76
SANILAC
49
20
-
-
206
1712541
00HQ
73
SAGINAW
34
IONIA
1
-
-
207
1712541
00HQ
73
SAGINAW
56
MIDLAND
1
-
208
1712541
00HQ
73
SAGINAW
63
OAKLAND
-
209
1712541
00HQ
73
SAGINAW
70
OTTAWA
210
1712541
00HQ
73
SAGINAW
73
211
1712541
00HQ
73
SAGINAW
79
Provider ID
Billing
Agent
Code F
176
1724945
00HJ
177
1724945
00HJ
178
1724945
180
1724945
181
Report Generated: 10/15/2007
12:47 PM
Male
Female
Male
Female
Male
Female
103,104
Male
Female
2
2
-
-
4
$
10,221
$
10,221
$
-
$
-
$
20,443
19
9
-
-
28
$
89,120
$
43,375
$
-
$
-
$
132,496
2
1
-
-
3
$
6,667
$
5,111
$
-
$
-
$
11,777
12
6
-
-
18
$
58,190
$
29,374
$
-
$
-
$
87,564
-
-
-
1
$
5,111
$
-
$
-
$
-
$
5,111
-
4
$
10,221
$
10,221
$
-
$
-
$
20,443
-
63
$
222,264
$
101,060
$
-
$
-
$
323,323
-
15
$
54,927
$
20,443
$
-
$
-
$
75,370
-
12
$
20,443
$
40,885
$
-
$
-
$
61,328
-
10
$
35,775
$
14,042
$
-
$
-
$
49,816
-
-
2
$
5,111
$
3,820
$
-
$
-
$
8,931
-
-
55
$
186,727
$
90,680
$
-
$
-
$
277,407
-
1
$
5,111
$
-
$
-
$
-
$
5,111
-
1
$
5,111
$
-
$
-
$
-
$
5,111
-
20
$
48,018
$
30,720
$
2,688
$
-
$
81,426
-
1
$
-
$
4,153
$
-
$
-
$
4,153
-
-
1
$
-
$
5,528
$
-
$
-
$
5,528
6
-
-
10
$
20,860
$
32,361
$
-
$
-
$
53,220
29
20
-
-
49
$
151,430
$
106,886
$
-
$
-
$
258,315
4
1
-
-
5
$
22,989
$
5,244
$
-
$
-
$
28,232
HILLSDALE
-
1
-
-
1
$
-
$
3,146
$
-
$
-
$
3,146
KENT
-
1
-
-
1
$
-
$
3,639
$
-
$
-
$
3,639
139
$
418,729
$
280,679
$
-
$
2,758
$
702,166
69
$
266,815
$
112,748
$
-
$
-
$
379,563
-
1
$
4,557
$
-
$
-
$
-
$
4,557
-
-
1
$
4,252
$
-
$
-
$
-
$
4,252
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
1
-
-
-
1
$
4,557
$
-
$
-
$
-
$
4,557
SAGINAW
58
38
-
-
96
$
310,205
$
206,821
$
-
$
-
$
517,026
TUSCOLA
1
1
-
-
2
$
4,153
$
4,153
$
-
$
-
$
8,305
1
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 52 of 79
Habilitation Supports Waiver - Capitation by County
October, 2007
Detail by Population Group by Gender
Revenue is calculated based on County of Residence and Paid to Country of Financial Responsibility
Population - Current Enrollment
DAB Enrollees
County Name Residence
Revenue - Habilitation Supports Waiver
TANF Enrollees
Provider ID
Billing
Agent
Code F
212
2920843
00HR
08
BARRY
08
BARRY
213
2920843
00HR
11
BERRIEN
11
BERRIEN
214
2920843
00HR
11
BERRIEN
70
OTTAWA
1
-
-
215
2920843
00HR
12
BRANCH
12
BRANCH
19
24
-
216
2920843
00HR
12
BRANCH
80
VAN BUREN
2
-
-
217
2920843
00HR
13
CALHOUN
12
BRANCH
-
1
-
218
2920843
00HR
13
CALHOUN
13
CALHOUN
61
32
-
219
2920843
00HR
13
CALHOUN
14
CASS
-
1
-
220
2920843
00HR
13
CALHOUN
33
INGHAM
1
-
-
221
2920843
00HR
13
CALHOUN
39
KALAMAZOO
-
1
-
-
222
2920843
00HR
80
VAN BUREN
03
ALLEGAN
4
-
-
223
2920843
00HR
80
VAN BUREN
80
VAN BUREN
39
26
1
224
4390138
00HU
46
LENAWEE
46
LENAWEE
47
46
-
225
4390138
00HU
47
LIVINGSTON
25
GENESEE
1
1
-
226
4390138
00HU
47
LIVINGSTON
39
KALAMAZOO
2
-
227
4390138
00HU
47
LIVINGSTON
44
LAPEER
-
228
4390138
00HU
47
LIVINGSTON
45
LEELANAU
229
4390138
00HU
47
LIVINGSTON
47
230
4390138
00HU
58
MONROE
58
231
4390138
00HU
58
MONROE
82
WAYNE
1
-
-
232
4390138
00HU
81
WASHTENAW
25
GENESEE
1
-
-
233
4390138
00HU
81
WASHTENAW
40
KALKASKA
1
-
-
234
4390138
00HU
81
WASHTENAW
46
LENAWEE
-
1
235
4390138
00HU
81
WASHTENAW
63
OAKLAND
-
236
4390138
00HU
81
WASHTENAW
81
WASHTENAW
237
4390138
00HU
81
WASHTENAW
82
WAYNE
County Name - COFR Code R
State Subtotals
Male
Female
Male
TANF Capitation
DAB Capitation
Female
Total
Enrollees
Male
Female
Male
Total Capitation
Female
3
2
-
-
5
$
12,458
$
8,305
$
-
$
-
$
20,763
41
41
-
-
82
$
195,460
$
180,111
$
-
$
-
$
375,571
-
1
$
6,307
$
$
-
$
-
$
6,307
-
43
$
74,584
$
$
-
$
-
$
177,311
-
2
$
8,644
$
-
$
-
$
-
$
8,644
-
1
$
-
$
3,104
$
-
$
-
$
3,104
-
93
$
$
135,369
$
-
$
-
$
404,628
-
1
$
-
$
3,400
$
-
$
-
$
3,400
-
1
$
4,557
$
-
$
-
$
-
$
4,557
1
$
-
$
3,400
$
-
$
-
$
3,400
-
4
$
13,020
$
-
$
-
$
-
$
13,020
-
66
$
160,215
$
107,653
$
4,273
$
-
$
272,141
-
93
$
170,251
$
175,251
$
-
$
-
$
345,502
-
2
$
4,551
$
3,936
$
-
$
-
$
8,487
-
-
2
$
6,800
$
-
$
-
$
-
$
6,800
1
-
-
1
$
-
$
5,244
$
-
$
-
$
5,244
1
-
-
-
1
$
3,406
$
-
$
-
$
-
$
3,406
LIVINGSTON
61
29
1
-
91
$
243,914
$
114,678
$
2,833
$
-
$
361,426
MONROE
62
51
-
-
113
$
242,461
$
189,772
$
-
$
-
$
432,233
-
1
$
5,698
$
-
$
-
$
-
$
5,698
-
1
$
3,639
$
-
$
-
$
-
$
3,639
-
1
$
5,361
$
-
$
-
$
-
$
5,361
-
-
1
$
-
$
4,551
$
-
$
-
$
4,551
1
-
-
1
$
-
$
4,957
$
-
$
-
$
4,957
144
-
1
339
$
769,475
$
551,381
$
-
$
2,720
$
1,323,576
-
-
-
1
$
4,928
$
$
-
$
-
$
4,928
3
7,223
$
18,171,301
$
$
24,801
$
8,086
$
31,166,072
12
-
32,887
$
31,166,072
194
1
4,201
3,010
7,211
9
269,259
102,727
12,961,885
31,133,186
-
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW by County
Page 53 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - DAB - Male
M
DAB
October, 2007
Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
1
16
43
42
83
32
217
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
4
17
39
57
71
26
214
3
4344340
00GG
CMH for Central Michigan
M
DAB
-
18
66
96
89
33
302
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
-
14
30
21
34
2
101
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
4
24
124
187
240
47
626
6
1705233
0028
Genesee County CMH Services
M
DAB
4
15
49
70
54
14
206
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
-
8
27
37
43
6
121
8
1712229
00GV
Lifeways
M
DAB
-
14
50
33
46
18
161
00GX
Macomb County CMH Services
M
DAB
4
15
44
75
72
20
230
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
13
26
45
54
58
29
225
11
4476125
00HF
Northern Affiliation
M
DAB
1
6
51
65
85
39
247
12
4540048
00HC
Northern Lakes
M
DAB
3
6
25
26
29
6
95
13
1705289
0058
Oakland County CMH Authority
M
DAB
7
15
122
152
116
20
432
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
-
2
18
18
19
5
62
15
4390138
00HU
Southeast Partnership
M
DAB
2
32
136
87
90
25
372
16
3402136
00GR
Southwest Alliance
M
DAB
-
21
68
65
79
20
253
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
5
8
32
51
57
13
166
18
2920843
00HR
Venture Behavioral Health
M
DAB
2
15
45
56
46
7
171
-
19
20
State Subtotals
50
272
1,014
1,192
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
1,311
362
4,201
-
Page 54 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - DAB - Female
F
DAB
October, 2007
Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
-
7
35
30
51
20
143
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
-
9
27
31
54
15
136
3
4344340
00GG
CMH for Central Michigan
F
DAB
-
8
37
54
89
24
212
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
-
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
4
6
1705233
0028
Genesee County CMH Services
F
DAB
3
8
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
-
5
8
1712229
00GV
Lifeways
F
DAB
1
4
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
4
13
12
28
2
59
21
95
122
204
59
505
28
46
43
18
146
21
27
40
11
104
24
17
41
10
97
9
3396315
00GX
Macomb County CMH Services
F
DAB
-
9
38
49
62
20
178
10
1724945
00HJ
Northcare
F
DAB
4
7
21
30
53
14
129
11
4476125
00HF
Northern Affiliation
F
DAB
1
4
39
33
55
30
162
12
4540048
00HC
Northern Lakes
F
DAB
1
4
17
20
21
10
73
13
1705289
0058
Oakland County CMH Authority
F
DAB
3
10
83
115
99
26
336
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
-
1
9
12
12
6
40
15
4390138
00HU
Southeast Partnership
F
DAB
-
17
71
93
67
26
274
16
3402136
00GR
Southwest Alliance
F
DAB
3
10
47
54
58
19
191
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
1
1
22
30
33
10
97
18
2920843
00HR
Venture Behavioral Health
F
DAB
1
10
29
37
40
11
128
-
19
20
State Subtotals
22
139
656
812
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
1,050
331
3,010
-
Page 55 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - TANF - Male
M
TANF
October, 2007
Population - Current Enrollment by Age Group
Provider ID
Billing
Agent
1
4344340
00GG
CMH for Central Michigan
M
TANF
2
-
-
-
-
-
2
2
1705233
0028
Genesee County CMH Services
M
TANF
1
-
-
-
-
-
1
3
3396315
00GX
Macomb County CMH Services
M
TANF
1
1
-
-
-
-
2
4
1724945
00HJ
Northcare
M
TANF
2
-
-
-
-
-
2
5
4390138
00HU
Southeast Partnership
M
TANF
-
1
-
-
-
-
1
6
2920843
00HR
Venture Behavioral Health
M
TANF
-
1
-
-
-
-
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
1
7
-
8
-
9
-
10
-
11
-
12
-
13
-
14
-
15
-
16
-
17
-
18
-
19
-
20
State Subtotals
6
3
-
-
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
-
-
9
-
Page 56 of 79
Habilitation Supports Waiver - Population by PIHP by Age Group - TANF - Female
F
TANF
October, 2007
Population - Current Enrollment by Age Group
Provider ID
Billing
Agent
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
1
1705289
0058
Oakland County CMH Authority
F
TANF
1
-
-
-
-
-
1
2
4390138
00HU
Southeast Partnership
F
TANF
-
-
1
-
-
-
1
3
1708164
00HO
Thumb Mental Health Alliance
F
TANF
1
-
-
-
-
-
1
4
-
5
-
6
-
7
-
8
-
9
-
10
-
11
-
12
-
13
-
14
-
15
-
16
-
17
-
18
-
19
-
20
State Subtotals
2
-
1
-
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-Pop
-
-
3
-
Page 57 of 79
Habilitation Supports Waiver - Revenue by PIHP by Age Group - DAB - Male
M
DAB
October, 2007
Revenue for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
M
DAB
$
2,184
$
66,052
$
184,169
$
182,256
$
365,768
$
140,645
$
941,074
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
M
DAB
$
9,587
$
61,629
$
180,853
$
271,215
$
341,124
$
127,200
$
991,606
3
4344340
00GG
CMH for Central Michigan
M
DAB
$
-
$
51,639
$
237,052
$
351,810
$
320,416
$
119,861
$
1,080,777
4
4483587
00GS
CMHSA Network of West Michigan
M
DAB
$
-
$
46,653
$
109,221
$
76,427
$
123,117
$
7,279
$
362,697
5
3119549
00GJ
Detroit Wayne County CMH Agency
M
DAB
$
10,738
$
95,600
$
590,027
$
935,747
$
1,186,042
$
236,506
$
3,054,659
6
1705233
0028
Genesee County CMH Services
M
DAB
$
7,657
$
46,433
$
174,886
$
255,078
$
200,722
$
50,951
$
735,727
7
1712452
00HA
Lakeshore Behavioral Health Alliance
M
DAB
$
-
$
34,143
$
120,281
$
169,703
$
196,275
$
26,190
$
546,591
8
1712229
00GV
Lifeways
M
DAB
$
-
$
30,818
$
106,996
$
76,071
$
108,052
$
40,313
$
362,251
00GX
Macomb County CMH Services
M
DAB
$
9,183
$
48,772
$
149,830
$
276,971
$
265,987
$
76,701
$
827,443
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
10
1724945
00HJ
Northcare
M
DAB
$
42,232
$
117,687
$
228,855
$
284,287
$
296,742
$
151,153
$
1,120,956
11
4476125
00HF
Northern Affiliation
M
DAB
$
2,607
$
29,882
$
263,930
$
344,051
$
446,701
$
204,662
$
1,291,833
12
4540048
00HC
Northern Lakes
M
DAB
$
7,190
$
22,732
$
103,399
$
118,914
$
134,424
$
27,712
$
414,371
13
1705289
0058
Oakland County CMH Authority
M
DAB
$
18,250
$
56,970
$
590,673
$
743,352
$
613,029
$
105,250
$
2,127,523
14
1712541
00HQ
Saginaw County CMH Authority
M
DAB
$
-
$
11,113
$
92,015
$
93,697
$
102,665
$
28,232
$
327,723
15
4390138
00HU
Southeast Partnership
M
DAB
$
3,829
$
119,812
$
524,766
$
345,178
$
360,912
$
105,987
$
1,460,484
16
3402136
00GR
Southwest Alliance
M
DAB
$
-
$
68,483
$
237,852
$
245,357
$
295,198
$
74,228
$
921,118
17
1708164
00HO
Thumb Mental Health Alliance
M
DAB
$
15,114
$
36,652
$
158,514
$
274,756
$
305,447
$
69,479
$
859,962
18
2920843
00HR
Venture Behavioral Health
M
DAB
$
4,369
$
59,109
$
198,450
$
255,273
$
197,557
$
29,746
$
744,504
$
132,940
$
1,004,179
$
4,251,769
$
5,300,142
$
5,860,176
$
1,622,094
$
18,171,301
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-DAB
-
Page 58 of 79
Habilitation Supports Waiver - Revenue by PIHP by Age Group - DAB - Female
F
DAB
October, 2007
Revenue for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
1705322
00GE
Access Alliance of Michigan
F
DAB
$
-
$
27,234
$
151,408
$
131,767
$
214,749
$
90,475
$
615,633
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
F
DAB
$
-
$
34,370
$
123,023
$
149,679
$
265,178
$
70,623
$
642,873
3
4344340
00GG
CMH for Central Michigan
F
DAB
$
-
$
24,896
$
131,476
$
182,067
$
319,697
$
84,118
$
742,254
4
4483587
00GS
CMHSA Network of West Michigan
F
DAB
$
-
$
10,882
$
48,088
$
45,071
$
106,098
$
7,279
$
217,417
5
3119549
00GJ
Detroit Wayne County CMH Agency
F
DAB
$
11,109
$
77,898
$
452,292
$
616,275
$
1,011,761
$
292,301
$
2,461,637
6
1705233
0028
Genesee County CMH Services
F
DAB
$
5,743
$
24,633
$
105,304
$
172,086
$
162,087
$
66,907
$
536,759
7
1712452
00HA
Lakeshore Behavioral Health Alliance
F
DAB
$
-
$
19,332
$
95,174
$
124,544
$
183,771
$
50,124
$
472,944
8
1712229
00GV
Lifeways
F
DAB
$
1,195
$
8,512
$
51,189
$
38,406
$
92,940
$
22,705
$
214,948
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
9
3396315
00GX
Macomb County CMH Services
F
DAB
$
-
$
28,777
$
120,200
$
177,025
$
226,959
$
69,612
$
622,574
10
1724945
00HJ
Northcare
F
DAB
$
10,753
$
32,062
$
98,291
$
148,469
$
272,342
$
75,805
$
637,721
11
4476125
00HF
Northern Affiliation
F
DAB
$
2,607
$
17,323
$
188,095
$
167,577
$
280,403
$
151,978
$
807,983
12
4540048
00HC
Northern Lakes
F
DAB
$
3,547
$
15,288
$
72,862
$
95,236
$
97,441
$
45,939
$
330,313
13
1705289
0058
Oakland County CMH Authority
F
DAB
$
7,821
$
39,405
$
388,149
$
575,011
$
506,588
$
133,137
$
1,650,111
14
1712541
00HQ
Saginaw County CMH Authority
F
DAB
$
-
$
2,758
$
46,494
$
68,265
$
66,952
$
31,461
$
215,930
15
4390138
00HU
Southeast Partnership
F
DAB
$
-
$
62,288
$
270,041
$
346,607
$
270,439
$
100,395
$
1,049,770
16
3402136
00GR
Southwest Alliance
F
DAB
$
6,501
$
28,262
$
170,203
$
198,934
$
212,149
$
70,557
$
686,606
17
1708164
00HO
Thumb Mental Health Alliance
F
DAB
$
2,758
$
5,244
$
113,307
$
160,612
$
177,986
$
52,436
$
512,342
18
2920843
00HR
Venture Behavioral Health
F
DAB
$
2,184
$
36,033
$
120,148
$
162,658
$
174,996
$
48,051
$
544,070
$
54,220
$
495,197
$
2,745,743
$
3,560,289
$
4,642,535
$
1,463,901
$
12,961,885
19
20
State Subtotals
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-DAB
-
Page 59 of 79
Habilitation Supports Waiver - Revenue by PIHP by Age Group - TANF - Male
M
TANF
October, 2007
Capitation for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
1
4344340
00GG
CMH for Central Michigan
M
TANF
$
3,973
$
-
$
-
$
-
$
-
$
-
$
3,973
2
1705233
0028
Genesee County CMH Services
M
TANF
$
1,914
$
-
$
-
$
-
$
-
$
-
$
1,914
3
3396315
00GX
Macomb County CMH Services
M
TANF
$
2,849
$
3,583
$
-
$
-
$
-
$
-
$
6,432
4
1724945
00HJ
Northcare
M
TANF
$
5,376
$
-
$
-
$
-
$
-
$
-
$
5,376
5
4390138
00HU
Southeast Partnership
M
TANF
$
-
$
2,833
$
-
$
-
$
-
$
-
$
2,833
6
2920843
00HR
Venture Behavioral Health
M
TANF
$
-
$
4,273
$
-
$
-
$
-
$
-
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
$
4,273
7
$
-
8
$
-
9
$
-
10
$
-
11
$
-
12
$
-
13
$
-
14
$
-
15
$
-
16
$
-
17
$
-
18
$
-
$
24,801
19
20
State Subtotals
$
14,112
$
10,689
$
-
$
-
$
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-TANF
-
$
-
-
Page 60 of 79
Habilitation Supports Waiver - Revenue by PIHP by Age Group - TANF - Female
F
TANF
October, 2007
Capitation for Current Enrolled Population by Age Group
Provider ID
Billing
Agent
Affiliation DBA
Sex
Group
0 - 17
18 - 25
26 - 39
40 - 49
50 - 64
65+
Total
1
1705289
0058
Oakland County CMH Authority
F
TANF
$
2,607
$
-
$
-
$
-
$
-
$
-
$
2,607
2
4390138
00HU
Southeast Partnership
F
TANF
$
-
$
-
$
2,720
$
-
$
-
$
-
$
2,720
3
1708164
00HO
Thumb Mental Health Alliance
F
TANF
$
2,758
$
-
$
-
$
-
$
-
$
-
$
2,758
4
$
-
5
$
-
6
$
-
7
$
-
8
$
-
9
$
-
10
$
-
11
$
-
12
$
-
13
$
-
14
$
-
15
$
-
16
$
-
17
$
-
18
$
-
$
8,086
19
20
State Subtotals
$
5,365
$
-
$
2,720
$
-
$
Check Values
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-TANF
-
$
-
-
Page 61 of 79
Habilitation Supports Waiver - Summary by PIHP
October, 2007
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
$
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3
4344340
00GG
CMH for Central Michigan
4
4483587
00GS
5
3119549
6
1705233
7
Retro Payments
FY 2007-2008
Retro Payments
FY 2006-2007
1,556,707
$
-
$
49,859
$
1,606,566
$
1,634,479
$
-
$
50,400
$
1,684,879
$
1,827,005
$
-
$
97,682
$
1,924,687
CMHSA Network of West Michigan
$
580,114
$
-
$
(29,927) $
550,188
00GJ
Detroit Wayne County CMH Agency
$
5,516,296
$
-
$
(400,910) $
5,115,385
0028
Genesee County CMH Services
$
1,274,400
$
-
$
35,243
$
1,309,644
1712452
00HA
Lakeshore Behavioral Health Alliance
$
1,019,535
$
-
$
(9,361) $
1,010,174
8
1712229
00GV
Lifeways
$
577,199
$
-
$
11,619
$
588,818
9
3396315
00GX
Macomb County CMH Services
$
1,456,449
$
-
$
243,256
$
1,699,705
10
1724945
00HJ
Northcare
$
1,764,053
$
-
$
6,706
$
1,770,759
11
4476125
00HF
Northern Affiliation
$
2,099,816
$
-
$
127,562
$
2,227,379
12
4540048
00HC
Northern Lakes
$
744,685
$
-
$
43,805
$
788,489
13
1705289
0058
Oakland County CMH Authority
$
3,780,242
$
-
$
361,032
$
4,141,273
14
1712541
00HQ
Saginaw County CMH Authority
$
543,652
$
-
$
8,204
$
551,857
15
4390138
00HU
Southeast Partnership
$
2,515,808
$
-
$
169,137
$
2,684,945
16
3402136
00GR
Southwest Alliance
$
1,607,725
$
-
$
57,554
$
1,665,279
17
1708164
00HO
Thumb Mental Health Alliance
$
1,375,062
$
-
$
98,966
$
1,474,028
18
2920843
00HR
Venture Behavioral Health
$
1,292,847
$
-
$
(788,428) $
504,418
Current Payments
Total Payments
19
$
-
20
$
-
State Subtotals $
Report Generated: 10/15/2007
12:47 PM
31,166,072
$
-
$
132,400
$
31,298,472
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW-SUMMARY
Page 62 of 79
HSW Net Summaries - To Date By Month by PIHP
October, 2007
HSW Net Enrollees and Net Payments As of 10/15/2007
October
November
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
360 $
1,556,707
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
350 $
1,634,479
3
4344340
00GG
CMH for Central Michigan
516 $
1,827,005
4
4483587
00GS
CMHSA Network of West Michigan
160 $
580,114
5
3119549
00GJ
Detroit Wayne County CMH Agency
1,131 $
5,516,296
6
1705233
0028
Genesee County CMH Services
353 $
1,274,400
7
1712452
00HA
Lakeshore Behavioral Health Alliance
225 $
1,019,535
8
1712229
00GV
Lifeways
258 $
577,199
January
HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments
9
3396315
00GX
Macomb County CMH Services
410 $
1,456,449
10
1724945
00HJ
Northcare
356 $
1,764,053
11
4476125
00HF
Northern Affiliation
409 $
2,099,816
12
4540048
00HC
Northern Lakes
168 $
744,685
13
1705289
0058
Oakland County CMH Authority
769 $
3,780,242
14
1712541
00HQ
Saginaw County CMH Authority
102 $
543,652
15
4390138
00HU
Southeast Partnership
648 $
2,515,808
16
3402136
00GR
Southwest Alliance
444 $
1,607,725
17
1708164
00HO
Thumb Mental Health Alliance
264 $
1,375,062
18
2920843
00HR
Venture Behavioral Health
300 $
1,292,847
7,223 $
31,166,072
State Subtotals
Report Generated: 10/15/2007
December
12:47 PM
0 $
-
0 $
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW Net Enrollees & Payments
-
0 $
-
Page 63 of 79
HSW Net Summaries - To Date By Month by PIHP
October, 2007
HSW Net Enrollees and Net Payments As of 10/15/2007
February
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3
4344340
00GG
CMH for Central Michigan
4
4483587
00GS
CMHSA Network of West Michigan
5
3119549
00GJ
Detroit Wayne County CMH Agency
6
1705233
0028
Genesee County CMH Services
7
1712452
00HA
Lakeshore Behavioral Health Alliance
8
1712229
00GV
Lifeways
April
May
HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments
9
3396315
00GX
Macomb County CMH Services
10
1724945
00HJ
Northcare
11
4476125
00HF
Northern Affiliation
12
4540048
00HC
Northern Lakes
13
1705289
0058
Oakland County CMH Authority
14
1712541
00HQ
Saginaw County CMH Authority
15
4390138
00HU
Southeast Partnership
16
3402136
00GR
Southwest Alliance
17
1708164
00HO
Thumb Mental Health Alliance
18
2920843
00HR
Venture Behavioral Health
State Subtotals
Report Generated: 10/15/2007
March
12:47 PM
0 $
-
0 $
-
0 $
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW Net Enrollees & Payments
-
0 $
-
Page 64 of 79
HSW Net Summaries - To Date By Month by PIHP
October, 2007
HSW Net Enrollees and Net Payments As of 10/15/2007
June
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
3
4344340
00GG
CMH for Central Michigan
4
4483587
00GS
CMHSA Network of West Michigan
5
3119549
00GJ
Detroit Wayne County CMH Agency
6
1705233
0028
Genesee County CMH Services
7
1712452
00HA
Lakeshore Behavioral Health Alliance
8
1712229
00GV
Lifeways
August
September
HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments HSW Net Enrollees HSW Net Payments
9
3396315
00GX
Macomb County CMH Services
10
1724945
00HJ
Northcare
11
4476125
00HF
Northern Affiliation
12
4540048
00HC
Northern Lakes
13
1705289
0058
Oakland County CMH Authority
14
1712541
00HQ
Saginaw County CMH Authority
15
4390138
00HU
Southeast Partnership
16
3402136
00GR
Southwest Alliance
17
1708164
00HO
Thumb Mental Health Alliance
18
2920843
00HR
Venture Behavioral Health
State Subtotals
Report Generated: 10/15/2007
July
12:47 PM
0 $
-
0 $
-
0 $
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW Net Enrollees & Payments
-
0 $
-
Page 65 of 79
HSW Net Summaries - To Date By Month by PIHP
October, 2007
HSW Net Enrollees and Net Payments As of 10/15/2007
Year to Date
Provider ID
Billing
Agent
Affiliation DBA
1
1705322
00GE
Access Alliance of Michigan
360 $
1,556,707
2
1708001
00BJ
CMH Affiliation of Mid-Michigan
350 $
1,634,479
3
4344340
00GG
CMH for Central Michigan
516 $
1,827,005
4
4483587
00GS
CMHSA Network of West Michigan
160 $
580,114
5
3119549
00GJ
Detroit Wayne County CMH Agency
1,131 $
5,516,296
6
1705233
0028
Genesee County CMH Services
353 $
1,274,400
7
1712452
00HA
Lakeshore Behavioral Health Alliance
225 $
1,019,535
8
1712229
00GV
Lifeways
258 $
577,199
HSW Net Enrollees HSW Net Payments
9
3396315
00GX
Macomb County CMH Services
410 $
1,456,449
10
1724945
00HJ
Northcare
356 $
1,764,053
11
4476125
00HF
Northern Affiliation
409 $
2,099,816
12
4540048
00HC
Northern Lakes
168 $
744,685
13
1705289
0058
Oakland County CMH Authority
769 $
3,780,242
14
1712541
00HQ
Saginaw County CMH Authority
102 $
543,652
15
4390138
00HU
Southeast Partnership
648 $
2,515,808
16
3402136
00GR
Southwest Alliance
444 $
1,607,725
17
1708164
00HO
Thumb Mental Health Alliance
264 $
1,375,062
18
2920843
00HR
Venture Behavioral Health
300 $
1,292,847
7,223 $
31,166,072
State Subtotals
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
HSW Net Enrollees & Payments
Page 66 of 79
Affiliations
October, 2007
Provider
PIHP
Provider ID
PIHP
Billing
Agent ID
1
1705322
00GE
Access Alliance of Michigan
Bay-Arenac CMH
2
1705322
00GE
Access Alliance of Michigan
Bay-Arenac CMH
09
Bay
Bay-Arenac Behavioral Health
3
1705322
00GE
Access Alliance of Michigan
Huron Behavioral Health
32
Huron
Bay-Arenac Behavioral Health
4
1705322
00GE
Access Alliance of Michigan
Montcalm Center Behavl. Hlt
59
Montcalm
Bay-Arenac Behavioral Health
5
1705322
00GE
Access Alliance of Michigan
Shiawassee County CMH
78
Shiawassee
Bay-Arenac Behavioral Health
6
1705322
00GE
Access Alliance of Michigan
Tuscola County CMH
79
Tuscola
Bay-Arenac Behavioral Health
7
1708001
00BJ
CMH Affiliation of Mid-Michigan
CEI CMH
19
Clinton
Mid-South CA
8
1708001
00BJ
CMH Affiliation of Mid-Michigan
CEI CMH
23
Eaton
Mid-South CA
9
1708001
00BJ
CMH Affiliation of Mid-Michigan
CEI CMH
33
Ingham
Mid-South CA
10
1708001
00BJ
CMH Affiliation of Mid-Michigan
Gratiot County CMH
29
Gratiot
Mid-South CA
11
1708001
00BJ
CMH Affiliation of Mid-Michigan
Ionia County CMH
34
Ionia
Mink Substance Abuse Coordinating Agency
12
1708001
00BJ
CMH Affiliation of Mid-Michigan
Manistee-Benzie CMH
10
Benzie
Northern Michigan CA
13
1708001
00BJ
CMH Affiliation of Mid-Michigan
Manistee-Benzie CMH
51
Manistee
Northern Michigan CA
14
1708001
00BJ
CMH Affiliation of Mid-Michigan
Newaygo County CMH
62
Newaygo
Mink Substance Abuse Coordinating Agency
15
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
18
Clare
Northern Michigan CA
16
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
26
Gladwin
Northern Michigan CA
17
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
37
Isabella
Northern Michigan CA
18
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
54
Mecosta
Northern Michigan CA
19
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
56
Midland
Northern Michigan CA
20
4344340
00GG
CMH for Central Michigan
Central Michigan CMH
67
Osceola
Northern Michigan CA
21
4390138
00HU
CMH Partnership of Southeast Michigan
Lenawee County CMH
46
Lenawee
Mid-South CA
22
4390138
00HU
CMH Partnership of Southeast Michigan
Livingston County CMH
47
Livingston
Washtenaw County CMH
23
4390138
00HU
CMH Partnership of Southeast Michigan
Monroe County CMH
58
Monroe
Southeast MI Community Alliance
24
4390138
00HU
CMH Partnership of Southeast Michigan
Washtenaw County CMH
81
Washtenaw
Washtenaw County CMH
25
4483587
00GS
CMHSA Network of West Michigan
Kent County CMH
41
Kent
Mink Substance Abuse Coordinating Agency
26
3119549
00GJ
Detroit Wayne County CMH Agency
Detroit-Wayne County CMH
82
Wayne
Detroit Health Department
27
3119549
00GJ
Detroit Wayne County CMH Agency
Detroit-Wayne County CMH
82
Wayne
Southeast Michigan Community Alliance
28
1705233
0028
Genesee County CMH Services
Genesee County Health Dept
25
Genesee
Genesee County Health Dept
29
3402136
00GR
Kalamazoo PHP Affiliation
Allegan County CMH
03
Allegan
Lakeshore CA
Affiliation DBA
Report Generated: 10/15/2007
CMH Name
12:47 PM
County
Code
06
County Name
Arenac
CA Name
Bay-Arenac Behavioral Health
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Affiliations
Page 67 of 79
Affiliations
October, 2007
Provider
PIHP
Provider ID
PIHP
Billing
Agent ID
30
3402136
00GR
Kalamazoo PHP Affiliation
Kalamazoo County CMH
39
Kalamazoo
Kalamazoo County CMH
31
3402136
00GR
Kalamazoo PHP Affiliation
St. Joseph County CMH
75
St. Joseph
Kalamazoo County CMH
32
3402136
00GR
Kalamazoo PHP Affiliation
Woodlands Behavioral Healthcare
14
Cass
Lakeshore CA
33
1712452
00HA
Lakeshore Behavioral Health Alliance
Muskegon County CMH
61
Muskegon
Lakeshore CA
34
1712452
00HA
Lakeshore Behavioral Health Alliance
Ottawa County CMH
70
Ottawa
Lakeshore CA
35
1712229
00GV
Lifeways
Lifeways CMH
30
Hillsdale
Mid-South CA
36
1712229
00GV
Lifeways
Lifeways CMH
38
Jackson
Mid-South CA
37
3396315
00GX
Macomb County CMH Services
Macomb County CA
50
Macomb
Macomb County CA
38
1724945
00HJ
Northcare
Copper County CMH
07
Baraga
Western U.P. SAS
39
1724945
00HJ
Northcare
Copper County CMH
31
Houghton
Western U.P. SAS
40
1724945
00HJ
Northcare
Copper County CMH
42
Keweenaw
Western U.P. SAS
41
1724945
00HJ
Northcare
Copper County CMH
66
Ontonagon
Western U.P. SAS
42
1724945
00HJ
Northcare
Gogebic County CMH
27
Gogebic
Western U.P. SAS
43
1724945
00HJ
Northcare
Hiawatha Behavioral Health Authority
17
Chippewa
Pathways CA
44
1724945
00HJ
Northcare
Hiawatha Behavioral Health Authority
49
Mackinac
Pathways CA
45
1724945
00HJ
Northcare
Hiawatha Behavioral Health Authority
77
Schoolcraft
Pathways CA
46
1724945
00HJ
Northcare
Northpointe CMH
22
Dickinson
Western U.P. SAS
47
1724945
00HJ
Northcare
Northpointe CMH
36
Iron
Western U.P. SAS
48
1724945
00HJ
Northcare
Northpointe CMH
55
Menominee
Pathways CA
49
1724945
00HJ
Northcare
Pathways CMH
02
Alger
Pathways CA
50
1724945
00HJ
Northcare
Pathways CMH
21
Delta
Pathways CA
51
1724945
00HJ
Northcare
Pathways CMH
48
Luce
Pathways CA
52
1724945
00HJ
Northcare
Pathways CMH
52
Marquette
Pathways CA
53
4476125
00HF
Northern Affiliation
AuSable Valley CMH
35
Iosco
Northern Michigan CA
54
4476125
00HF
Northern Affiliation
AuSable Valley CMH
65
Ogemaw
Northern Michigan CA
55
4476125
00HF
Northern Affiliation
AuSable Valley CMH
68
Oscoda
Northern Michigan CA
56
4476125
00HF
Northern Affiliation
North Country CMHA
05
Antrim
Northern Michigan CA
57
4476125
00HF
Northern Affiliation
North Country CMHA
15
Charlevoix
Northern Michigan CA
58
4476125
00HF
Northern Affiliation
North Country CMHA
16
Cheboygan
Northern Michigan CA
Affiliation DBA
Report Generated: 10/15/2007
CMH Name
12:47 PM
County
Code
County Name
CA Name
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Affiliations
Page 68 of 79
Affiliations
October, 2007
Provider
PIHP
Provider ID
PIHP
Billing
Agent ID
59
4476125
00HF
Northern Affiliation
North Country CMHA
24
Emmet
Northern Michigan CA
60
4476125
00HF
Northern Affiliation
North Country CMHA
40
Kalkaska
Northern Michigan CA
61
4476125
00HF
Northern Affiliation
North Country CMHA
69
Otsego
Northern Michigan CA
62
4476125
00HF
Northern Affiliation
Northeast Michigan CMH
01
Alcona
Northern Michigan CA
63
4476125
00HF
Northern Affiliation
Northeast Michigan CMH
04
Alpena
Northern Michigan CA
64
4476125
00HF
Northern Affiliation
Northeast Michigan CMH
60
Montmorency
Northern Michigan CA
65
4476125
00HF
Northern Affiliation
Northeast Michigan CMH
71
Presque Isle
Northern Michigan CA
66
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
20
Crawford
Northern Michigan CA
67
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
28
Grand Traverse
Northern Michigan CA
68
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
45
Leelanau
Northern Michigan CA
69
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
57
Missaukee
Northern Michigan CA
70
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
72
Roscommon
Northern Michigan CA
71
4540048
00HC
Northwest CMH Affiliation
Northern Lakes CMH
83
Wexford
Northern Michigan CA
72
4540048
00HC
Northwest CMH Affiliation
West Michigan CMH
43
Lake
Northern Michigan CA
73
4540048
00HC
Northwest CMH Affiliation
West Michigan CMH
53
Mason
Northern Michigan CA
74
4540048
00HC
Northwest CMH Affiliation
West Michigan CMH
64
Oceana
Northern Michigan CA
75
1705289
0058
Oakland County CMH Authority
Oakland County CMHA
63
Oakland
Oakland County Health Div
76
1712541
00HQ
Saginaw County CMH Authority
Saginaw County CMH
73
Saginaw
Saginaw County Health Dept
77
1708164
00HO
Thumb Mental Health Alliance
Lapeer County CMH
44
Lapeer
St. Clair County Health Dept. CA
78
1708164
00HO
Thumb Mental Health Alliance
Sanilac County CMH
76
Sanilac
St. Clair County Health Dept. CA
79
1708164
00HO
Thumb Mental Health Alliance
St. Clair County CMH
74
St. Clair
St. Clair County Health Dept. CA
80
2920843
00HR
Venture Behavioral Health
Barry County CMH
08
Barry
Kalamazoo County CMH
81
2920843
00HR
Venture Behavioral Health
Berrien Mental Health
11
Berrien
Lakeshore CA
82
2920843
00HR
Venture Behavioral Health
Pines Behavioral Health CMH
12
Branch
Kalamazoo County CMH
83
2920843
00HR
Venture Behavioral Health
Summit Pointe CMH
13
Calhoun
Mid-South CA
84
2920843
00HR
Venture Behavioral Health
Van Buren County CMH
80
Van Buren
Kalamazoo County CMH
Affiliation DBA
Report Generated: 10/15/2007
CMH Name
12:47 PM
County
Code
County Name
CA Name
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Affiliations
Page 69 of 79
Capitation Statewide Base Rates
October, 2007
To avoid problems with transmitting data in HIPAA compliant formats, all capitation rates are set to a minimum of $0.01.
Mental Health
Program
Code Group
Fund Source
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
Date Effective
Report Generated: 10/15/2007
12:47 PM
Date Ended
MH Base Rate
Current
Value
Comments
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Cap Base Rates
Page 70 of 79
Capitation Statewide Base Rates
October, 2007
To avoid problems with transmitting data in HIPAA compliant formats, all capitation rates are set to a minimum of $0.01.
Substance Abuse
Program
Code Group
Fund Source
DAB
1915(b)(3)
DAB
State Plan
TANF
1915(b)(3)
TANF
State Plan
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
Date Effective
Report Generated: 10/15/2007
12:47 PM
Date Ended
SA Base Rate
Current
Value
Comments
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Cap Base Rates
Page 71 of 79
Mental Health Age-Sex Factors (Apply to State Plan and 1915(b)(3) and Habilitation Supports Waiver)
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
October, 2007
Program
Gender
Code Group
Age
Report Generated: 10/15/2007
Date Effective
12:47 PM
Date Ended
MH Age Sex
Factor
Current
Value
Comments
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
AgeSex Factors MH
Page 72 of 79
Substance Abuse Age-Sex Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
October, 2007
Program
Gender
Code Group
AGE
Report Generated: 10/15/2007
Date Effective
12:47 PM
Date Ended
SA Age Sex
Factor
Current
Value
Comments
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
AgeSex Factors SA
Page 73 of 79
Mental Health Geographic Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
October, 2007
Provider ID
Billing
Agent ID
Report Generated: 10/15/2007
Provider Name
12:47 PM
Program
Code Group
Effective
Payment
Month
Date Effective
Date Ended
MH
Geographic
Factor
Current
Value
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Geographic Factors MH
Comments
Page 74 of 79
Mental Health Geographic Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
October, 2007
Provider ID
Billing
Agent ID
Report Generated: 10/15/2007
Provider Name
12:47 PM
Program
Code Group
Effective
Payment
Month
Date Effective
Date Ended
MH
Geographic
Factor
Current
Value
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Geographic Factors MH
Comments
Page 75 of 79
Substance Abuse Geographic Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
October, 2007
Provider ID
Billing
Agent ID
Report Generated: 10/15/2007
Provider Name
12:47 PM
Program
Code Group
Effective
Payment
Month
Date Effective
Date Ended
SA Geographic
Factor
Current
Value
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Geographic Factors SA
Comments
Page 76 of 79
Substance Abuse Geographic Factors (Apply to State Plan and 1915(b)(3))
Base Rate X AgeSex Factor X Geographic Factor = Capitation Rate
October, 2007
Provider ID
Billing
Agent ID
Report Generated: 10/15/2007
Provider Name
12:47 PM
Program
Code Group
Effective
Payment
Month
Date Effective
Date Ended
SA Geographic
Factor
Current
Value
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
Geographic Factors SA
Comments
Page 77 of 79
MA - Population by Age - Do Not Print
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
NP - Age Profile Data
Page 78 of 79
HSW - Population by Age - Do Not Print
Report Generated: 10/15/2007
12:47 PM
MDCH Mental Health & Substance Abuse Specialty Services and Habilitation Supports Waiver Capitation Report
NP - HSW Age Profile Data
Page 79 of 79
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